SAD: Don’t Suffer, Get Help

| Graceful Health

By Benjamin Wright, Psychiatric Nurse Practitioner, Grace Cottage Family Health

Do you have the winter blues? Winters can be long and difficult here in Vermont. The most recent weeks of temperatures well below zero certainly gave our community a spell of hard New England weather. Cold weather and heavy snow falls can limit outdoor activities. With less time spent in outdoor activities, less exercise, long nights and less time in the sun during the winter months, some people experience sad moods.

When the symptoms of the winter blues become severe, they could mean the person is experiencing Seasonal Affective Disorder, also known as SAD. Seasonal Affective Disorder is a serious medical condition and is best treated by a medical provider. The symptoms of SAD include depressed mood, low energy, too much or too little sleep, change in appetite and weight, diminished interest in things that were once enjoyed, poor concentration and, in some cases, thoughts of suicide. These symptoms are also common in Major Depressive Disorder (MDD) but for the diagnosis of SAD, these symptoms must have a pattern of occurring and resolving during specific seasons of the year and must happen for 2 years in a row.

This reaction is not all in the mind. Medical research has discovered biological reasons for SAD and some of this research has shown that people with this disorder sometimes have difficulties with two important body chemicals, serotonin and melatonin. One study found that people with SAD often have a higher level of a protein that impacts serotonin levels, a chemical that affects nerves and moods. During the longer nights of winter, the increase of darkness leads to an increase of melatonin, the hormone that controls sleep. For some people, this extra melatonin causes feelings of depression and lethargy.

When we spend less time in the sun during the winter months, we are more likely to develop a Vitamin D deficiency and studies have linked low Vitamin D levels with depression. In addition to low Vitamin D levels, most of us do not get much exercise during the winter months, when we are more likely to stay indoors. Exercise has been shown to grow areas of the brain that are involved in mood regulation and we know that exercise causes the release of endorphins, which are brain chemicals that trigger positive feelings. If we reduce our exercise in the winter, we reduce the chance to grow the areas of the brain that combat depression and with less exercise, we do not reap the benefit of the positive feelings that accompany endorphin release.

Certain groups of people are more likely to develop SAD. Women are four times more likely than men to have SAD. Children and teens also have a higher tendency and those with a family history of depression are at a greater risk. Another factor that increases risk for SAD is the distance a person lives from the equator. The National Institutes of Health estimates only one percent of people who live in Florida suffer from SAD, whereas nearly 10 percent of people in New England have SAD. It appears sunlight makes a difference.

The most common treatments for people diagnosed with SAD are psychotherapy, medication, and light therapy. Some people can cope better when they are taught to replace negative thoughts with positive ones. Others need prescribed antidepressants. Still others benefit from sitting in front of a light box that mimics sunlight for a prescribed length of time. Exercise is important, too. Cross country skiing, snowshoeing, or taking brisk walks outdoors are good for your mental health and your physical health. The treatments mentioned here, when designed for the particular patient, can be very effective at relieving the symptoms of SAD. If you find that you feel depressed and sad during the winter months, please consider consulting your medical provider to find out if you have SAD and to determine the best treatment for your condition.

Bio: Benjamin Wright, PMHNP-BC, is a Board Certified Psychiatric Nurse Practitioner. He joined the Grace Cottage Family Health staff in 2015. He holds a BA in Psychology from the Univ. of Massachusetts, and Bachelor and Master of Science in Nursing degrees from the MGH Institute of Health Professions in Boston.