Search for tag: "seasonal"

Dr. Jones: It is really dark in the morning these days. Fall has beautiful colors and the days can be gorgeous, but they're getting short. Are you sad about that?

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Shorter and darker days in the northern latitudes affect mood for many people. About 1 in 20 people experience seasonal variation in depression, with fall and winter showing a rise in depression. Of those people who are affected with seasonal depression, four out of five are women. This condition has been called Seasonal Affective Disorder, appropriately shortened to SAD syndrome or Seasonal Depression.

In the extremes of latitude up near the Arctic Circle, the winter is associated with increased risks of suicide and the summer with light all day, and night has been associated with increased mood, even euphoria, really increased good mood. Symptoms of SAD include feelings of depression, worthlessness, low energy, and lack of interest in things you usually like to do. Other symptoms and behaviors are a sense of fatigue leading to oversleeping. Spending longer times under the covers with longer, dark days is common. Some women describe carbohydrate cravings, which if you give way to eating those Halloween candies and Christmas cookies can lead to fluctuating levels of glucose which can complicate mood stability and of course can add to seasonal weight gain, which is depressing.

Symptoms start in the fall and get better in the spring. This problem was independent of income and lifestyle factors. According to the National Institutes of Mental Health, the main risks for seasonal effective disorder are age, sex, history of depression, and distance from the equator. The condition seems to start in women in their 20s and 30s.

Why women are so much more likely to be affected isn't well understood. Some researchers have suggested that reduced sunlight can affect serotonin levels, a brain hormone that affects mood. Fluctuating estrogens, which women have and men don't so much, also affects serotonin. Also melatonin, a brain hormone produced in the dark can increase in dark days and adversely affect our sleep-wake rhythm. It can upset our circadian rhythms, which can be associated with depression. So if this is you, what to do?

Number one is phototherapy or bright light therapy in the mornings, and this has been shown to be effective in decreasing symptoms in up to 85% of women with Seasonal Affective Disorder. Now, this is really bright light, brighter than any light bulb, especially now with our new light bulbs. Special devices that deliver 10,000 lux. Lux, L-U-X, is a measurement of light. They are not very expensive and can be bought on the web for about $50 to $100, and some are more expensive than that. Make sure that the light box is designed to treat Seasonal Affective Disorder. You can search light box for Seasonal Affective Disorder and add 10,000 lux to the search term.

This bright light is like medicine. It can suppress melatonin, so it should be used in the morning. Sit about two feet away from the light box for 20 to 90 minutes while reading or doing some work. The light is bright, but don't put your sunglasses on. The UV light that might damage your eyes has been filtered out with these light boxes, so the bright light doesn't damage your eyes. If you find that you're getting out of bed later and later in the fall, using morning bright light therapy will help reset your biological clock so you can get up earlier.

Number two, go outside and get some natural light. In most of the western U.S., we have lots of light in the winter. It's often cloudier in the northeast and the north central states, so it can be harder to find natural, bright light, but just getting outside and going for a walk can make people feel better.

Number three, exercise makes you feel better. Even when it's the last thing you want to do, make an appointment with a friend or a kid and get some exercise. Regular exercise, especially early in the day, not before bedtime, has been shown to help regulate circadian rhythms, which can be important in treating SAD.

Number four, eat this, not that. Try to limit the sugar swings associated with high carb foods and sweets. This is the time to eat your protein and veggies. If you aren't getting enough vitamin D in the winter, which most of us won't because we live in northern cold climates and bundle up, leaving nothing exposed to get our natural vitamin D, you can get vitamin D naturally in fatty fish like salmon and in eggs. Some studies suggest that people with SAD are low in vitamin D and omega-3 fatty acids. Increasing sources of these in your diet is good for your heart and your brain anyway.

Number five. If you know that you're vulnerable to depression and decreased mood in the fall and winter months, get started early on activities and interventions that can help. Don't wait until the darkest days of your mood. Bright light therapy and planned diet and exercise changes early in the fall.

Six. My favorite recommendation is to change your venue. Go south, visiting climates that have more sun. Of course, this can be expensive and disruptive to the family, Thanksgiving and Christmas if mom bugs out to take a holiday on the beach, but it's just a thought. Of course, cranking up the heat in the house, getting a beach blanket and your shorts and sitting in front of a $50 light box is much cheaper, but not so much fun.

Finally, and importantly, this fall and winter holidays can be stressful for women. If you're already struggling with depression, substance abuse, anxiety and the dark days are making it worse, reach out for help to family, friends, and your clinician. You may not believe it in the dark days of your mood, but we can make it better. I'm off to dig up my light box. Thanks for joining us on The Scope.

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Interviewer: Ten percent of people living in Utah are at a higher risk for seasonal affective disorder. We're talking today with Dr. Jason Hunziker. First of all, why are we, living in Utah, at a higher risk?

Dr. Hunziker: There are a lot of theories as to why people who live in the northern latitudes are at higher risk of this type of depression. One of those theories is the fact that there just is not as much daylight in the north as there is closer to the Equator. So the further we get away from the Equator, the shorter the days become, the darker it becomes, and so people get more depressed.

Interviewer: And so, then it's true that sunlight actually makes you happy.

Dr. Hunziker: That's correct. People who live closer to the Equator have less chance of this type of depression.

Interviewer: Are there other risks then, being in Utah, besides not enough sun?

Dr. Hunziker: There are, and people who are at risk that live in Utah are people who are young, they're a lot more at risk. Women tend to be at a higher risk than men, at an almost ten times more likely to get this type of depression than men.

The other thing that occurs in Utah, that doesn't occur in other places, is our inversion. So time away from the sun, even on a bright day, we don't get that because the inversion's there to block the sun. People who live around tall buildings that block the sun tend to get more depressed. If your job is indoors, in the basement with no windows, during the winter you're really at risk.

Interviewer: And especially since we have Daylight Savings here in America, you get out of work at 5:00 and it's already dark.

Dr. Hunziker: That's right.

Interviewer: And so you don't really ever . . .

Dr. Hunziker: That's right.

Interviewer: And then you wake up at, you know, 6:00, 7:00 and it's still dark, and so you never really see the sun.

Dr. Hunziker: That's correct, and it can't just be the light in your office that makes the difference, it has to be the same wavelength as the sun to make a difference, which is why people use light boxes because that does help with most people who have this type of seasonal disorder.

Interviewer: So knowing that people in Utah are at higher risk for depression, tell me from a doctor's perspective exactly how dangerous that is.

Dr. Hunziker: Yeah. So depression can be extremely dangerous, and suicides rates, particularly in Utah, are quite high. And if depression of any type goes unchecked, it can lead to people thinking about ending their life, which is extremely important. So any time you're experiencing a depressed mood, it should be evaluated, at least by your primary care doctor to see if something else needs to be done.

Interviewer: So with depression being so serious, does it often get confused for somebody just being moody, then, because people get moody and they get upset, but when does that become depression? When does it become dangerous?

Dr. Hunziker: The way you can tell is if this lasts every day for at least two weeks, where you're feeling so terrible that you don't want to get out of bed, where you feel like you have to sleep all of the time. You have absolutely no energy, or interest, or desire to do anything with anyone. You notice that you're eating a ton, particularly carbohydrates. With this population that gets seasonal affective disorder, carbohydrates tend to be the big thing that they do. And then, of course, if you start having any thoughts about hurting yourself at any time, that's when it really needs to be addressed.

So in summary, I think that for those of us living in Utah, we are at higher risk, so we need to pay attention to those signs of depression. Particularly women, particularly young people, particularly people who work in environments where they're not around sunlight need to pay attention to this. If you notice that you're having any changes in your mood, please seek help.

updated: December 16, 2022
originally published: December 16, 2015

Seasonal Affective Disorder is not the same as winter blues. Ignoring your symptoms could make the holiday season less than jolly.

I'm Jason Hunziker, Psychiatrist at the University of Utah. And that's what coming up on The Scope.

Often with the winter blues even though you're feeling down and sad, your emotions can change based on the environment that you are in. If you're watching a show that's funny or happy you can laugh, or if somebody tells you a joke you can get happy or it's fun to out with your friends and it's still fun to go skiing, but other times you're feeling down and stressed.

With seasonal affective disorder your mood doesn't generally change. Things don't make you happy anymore and you don't find pleasure in those things that you used to find pleasure in. You're interest level drops and you prefer to stay by yourself rather than be around other people. Often you feel you are pretending to be happy just so that others around you won't know how sad you really are. The difference is the symptoms last longer, they are more severe, and they impact all aspects of your life.

Sometimes the patients are able to go through the whole winter without any treatment and it doesn't cause much disruption. However because this is a sub-type of depression, it can lead to more significant symptoms and problems.

This is different than just feeling the so called winter blues or seasonal funk as some people will say, because it actually impairs your life and the life of those around you when you have this type of depression.

The way that this can affect others in your life is that many of these symptoms of depression include isolation, avoidance, irritability, poor sleep, overeating, weight gain, sadness, crying episodes, all of those things which can impact your family and friends and coworkers.

The cause of season affective disorder is still not clear; however there are a few theories on how this illness comes about. One of those theories is the biological clock or circadian rhythm suggesting that because of less sunlight in the fall and winter you are more likely to have moments of depression and sadness.

Another theory is that melatonin levels also change when seasons change and then based on your melatonin production or melatonin levels you will also experience changes in your mood pattern.

And lastly serotonin levels are always looked at when we're talking about depression and changes in the serotonin particularly around stressful times such as the holidays can increase people's sadness and difficulty in coping with stress.

The literature would suggest that women are at a much higher risk of this illness than men; however when men do get seasonal affective disorder their symptoms are much more severe and place them at higher risk of self harm and suicide.

Those of us who live further from the equator are also more at risk, mainly because the changes in the dark and light patterns in our seasons make us more at risk. If you have a family history of someone with depression or anxiety or substance use disorder, you are also more at risk of this sub-type of depression.

The most common age that we start to see seasonal affective disorder is sometime around 20 years old. The age range generally is between 20 and 40; however depression can come at any time during your life. And if you do notice the symptoms of seasonal affective disorder what are you going to do about that? I think the important thing is to go in and talk to your primary care doctor, your family practice doctor, your nurse practitioner or whoever your healthcare provider is so that you can get the appropriate care and treatment for this syndrome.

The important things that you should talk to your doctor about when you recognize that these symptoms may be more than just the winter blues include when these symptoms start every year. If you notice that every year in September you start to have trouble sleeping, eat more, have trouble moving around, that's important for your doctor to know.

Looking at your history and telling your doctor how long these symptoms have been present, if it lasts from September to December, or if you've ever been suicidal, or if you notice you're drinking more alcohol during that time, it's very important for your doctor to know. If you have family history about depression, bipolar disorder, other mental illness your doctor should also know that as well.

And then after this appointment your doctor may suggest to you several different types of treatment. One of the most commonly recommended treatments for seasonal affective disorder is light therapy. Even though this treatment is not FDA approved, there is a lot of anecdotal evidence that the light therapy will work for this illness. Light therapy is composed of a box that sits on your desk or that you can carry with you that essentially is bright light that shines into your eyes for anywhere from 15 minutes to 2 hours a day to help you with your mood symptoms; based on the theory that the change in the amount of light that we get every day this treatment will help improve your mood symptoms.

Additional therapy could be medication use including SSRI medications like Prozac or Paxil or Zoloft or other medications like Wellbutrin that can be taken during this period of time that you have your symptoms and then with the help of your doctor you could come off of those medicines for the remainder of the year.

The holiday can be very stressful, family parties, family get togethers, seeing people that you really don't want to be around can be stressful at this time and having someone you can go to and talk to about these symptoms is very beneficial for most patients.

updated: December 21, 2021
originally published: December 10, 2014