• SAD? Or just blue?

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    By Dr. Micaela Wexler

    Are you feeling the post-holiday let down? After all the parties are over and the guests have left, many people feel anxiety, disappointment and depression. That is normal.

    However, if you are feeling depressed, tired, weak, achy or ANGRY, you might be SAD.
    The “winter blues” might be something more: you might have SAD – Seasonal Affective Disorder. This is a type of depression that occurs every year during the winter months. It’s not just the “winter blues,” which is a feeling of mild disappointment and irritation most people get as they cope with the challenges of winter.

    How do you know if you’re SAD and not just blue?
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    People with SAD feel the following:
    - worthless, guilty, tense
    - fatigue
    - down and depressed
    - arms and legs feel heavy, achy
    - increased headaches
    - irritable
    - worried, increased checking behavior
    - indecisive
    - increased urination, heart palpitations, stomach aches
    - difficulty focusing
    - suspicious, paranoid, think co-workers don’t like them
    - increased difficulty starting the day
    - increased insomnia

    These symptoms go on for at least two weeks at a time and can recur. They start in late fall and fade away in early spring.

    It isn’t in your head. Well, actually, it is: Seasonal Affective Disorder is caused by your hypothalamus, a part of your brain, secreting more melatonin when your eyes are exposed to less sunshine. So, if you’re having insomnia, don’t take melatonin. When light hits are eyes, melatonin starts to go down.

    There is also a decrease in serotonin caused by a decrease in physical activity. An additional contributing factor is the disruption of your circadian rhythms by the change in weather, shorter days and change in routine. Many people first notice these symptoms following the time change.

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    Women are at higher risk, as are people with a family history of depression. Living far from the equator doesn’t help.

    There are some dangerous symptoms you should not ignore:
    - feeling suicidal, or feeling that life just doesn’t matter – get help right away
    - irritability leading to behavior that is out of character: yelling at your children, physically abusing your children
    - social isolation that is out of character – missing your child’s school concert even though you were looking forward to it

    Why you shouldn’t ignore even mild symptoms:
    - Decreased focus can lead to problems with work, increased debt, child neglect
    - SAD can become major depression
    - suspicious thoughts can cause irreparable harm: premature termination of a job or relationship.
    - Many people file for divorce during these months.
    - your immune system can become depressed

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    Treatment is easy and effective

    - Increase physical activity – increases serotonin levels
    - Watch your diet: beware of giving in to carb craving; eat more nuts and fruits – maybe this is why fruitcake is a traditional fruit at this time of year
    - Eat more walnuts – have been shown to help make you less SAD
    - Make home brighter
    - Bundle up and step outside – nothing makes your home feel warmer than stepping in from the cold
    - run your depression away
    - light box therapy – treatment of choice for SAD

    Understanding Bright-Light Therapy
    - also known as Light Box Therapy

    Light Box therapy is the treatment of choice for Seasonal Affective Disorder. It also works for non-seasonal depression. It involves exposure to bright light for at least 30 minutes every morning. The effectiveness is supported by at least two meta-analyses.

    One study done in 2006 compared bright-light bright light therapy head to head with Prozac, and found both therapies equally effective. Bright-light therapy had the advantage of working FASTER with fewer side effects, ie no sexual side effects.

    What type of light works?

    Bright sunshine in the morning works best – not available in the winter time

    Light boxes – what to look for:
    Look for lamps with at least 5,000 lux
    - 10,000 lux require exposure for 30 minutes
    - 5,000 lux require exposure for 60 minutes
    - beware of blue light – not proven to be effective, may cause macular degeneration
    - light must shine in your face
    - research shows the bigger the better, less lux requires longer exposure

    Look at lux distance
    - 22 inches: normal distance from computer when working
    - 28 inches: distance from computer when you lean back in the chair

    Dawn stimulators:

    - require longer exposure
    - effective – eyes are more sensitive in the morning
    - help reset sleep-wake cycle
    - convenient – can use in bedroom

    As a psychiatrist I have seen several cases in which people attempt to use Light Box Therapy for treatment of Major Depressive Disorder (MDD). A person with MDD experiences the following for at least two weeks: depressed mood, decreased concentration, lack of motivation, decreased sexual drive, lack of interest in activities that once seemed fun, guilt that is constant or out of proportion, and disturbed sleep. A more serious symptom, that should be addressed immediately is suicidal thoughts. If you feel suicidal, please call 911 or go to the emergency room. Light Box Therapy is very effective for Seasonal Affective Disorder, and it might prevent you from falling into depressive episode, but on its own, it won’t help you climb out of one.

    If your symptoms are more severe than Seasonal Affective Disorder, then for your health and that of your family, see a psychiatrist or mental health provider for treatment.

    Wexler Family Psychiatry – mental health information for the whole family

    Categories: depression, family psychiatry, Seasonal Affective Disorder

    Tags: , ,

    2 thoughts on “SAD? Or just blue?

    • Judy McGuirk says:

      Thank you so much for sharing this information. It was very helpful and I seem to have a better understanding of a problem that I’ve had complications with for many years. It may somewhat help keep the house warmer by having my blinds and curtains closed in the winter time, but I like to keep most of mine open to allow as much sun and natural light in as possible during the daylight hours. This article was very well written, and I’m looking forward to reading additional ones that you post! ♥

    • Kidpsychdoc says:

      Thank you so much. I also have a blog that has articles on topics for adults. It is at wexlerpsychiatry.com. It has been up longer, and has a larger number or articles.
      Thank you for your feedback.
      Dr. Wexler

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