The sun also rises

seasonal affective disorder is real—and treatable

Like many Americans, Jane,* a 33-year-old journalist in Atlanta, isn't a winter person.

That's understandable. Icy windshields and dead car batteries can't compete with warm breezes as an ideal way to start the day. Most people would gladly have a little sunburn over bronchitis.

And while children glory in making snowmen and gulping hot cocoa, adults are more likely to focus on high heating bills and expanding waistlines this winter.

But for Jane, the season's short days and gray skies hold even more menace. “I dread the fall daylight saving time change,” she says. “Cold and dark isn't a good combination for me.”

She's not alone. While for many people January marks the onset of post-holiday letdown, winter blahs and cabin fever, Jane and millions of others endure a more serious and less common condition: seasonal affective disorder (SAD). And for them, the seemingly endless grind of going to work and coming home in darkness induces more than just sighs. It's serious.

Seasonal affective disorder is a form of depression that affects about 5 percent of the adult population in the United States, or nearly 10 million people. Many of those who suffer from SAD experience their first bout of the debilitating condition in their teens, 20s and early 30s, and the disorder can last a lifetime.

As with other forms of depression, the National Institute of Mental Health estimates that up to twice as many women as men are afflicted with SAD.

Jane is a textbook example of the typical sufferer in many ways. As a woman who grew up in the South, she experienced her first serious attack of SAD at the age of 24 after moving to New England. In fact, SAD strikes more people more severely the farther north they live, but Southerners are more likely to be tortured by the reverse: summer SAD, which affects less than 1 percent of the adult population and manifests itself in fair-weather depression.

Jane says she's not ashamed of the condition, but because of a lack of understanding about SAD and depression in general, she's not ready to go completely public. “I'm not embarrassed by it, but it's not something I talk to my coworkers about,” she says. “If you haven't experienced it, you can't really understand it.”

out of balance
People with SAD bear a variety of depression-related symptoms, usually starting in the months of October or November and lasting until March or April, when symptoms can disappear as quickly as morning frost in the spring thaw. Experiencing two consecutive winters of such discontent is the standard for a clinical diagnosis of SAD. As most patients have a family history of depression and other related disorders, SAD is likely to have a genetic origin and may actually be hereditary.

Norman E. Rosenthal, MD, and other researchers at the National Institute of Mental Health, first identified SAD in 1984. Now a psychiatrist in the Washington, DC, area, Rosenthal says the research is progressing incrementally. While scientists have yet to determine the precise causes of SAD, it appears to result from problems in the complicated ways the body responds to seasonal light changes. In victims of SAD, winter's increased darkness seems to upset the delicate balance of biorhythms and brain chemicals that regulate everything from hunger and libido to body temperature and sleep.

SAD triggers a hibernation-like response, causing a strong desire for slumber—a craving for going to bed early in the evening and staying under the covers as late as possible in the morning. Jane, who says she usually stays up until around midnight during the summer, often climbs into bed as early as 7:30 p.m. during the winter and has a hard time getting up in the morning. “I guess, in one sense, I feel like I'm more in tune with the seasonal patterns than people who go to bed at 11 and get up at 7 year-round,” she jokes. “I don't know how they function.”

When they're awake, people afflicted with SAD tend to be depressed, exhausted and downright miserable. Common symptoms include mental anguish, despair and irritability.

“It's just debilitating,” Jane says. “Having an understanding partner helps, but sometimes it's really hard even for him to understand how I could be so upset for no apparent reason.”

SAD sufferers also tend to have difficulty concentrating at work and can find it hard to maintain their usual routines. As a writer and editor, keeping a sharp mental edge is critical for Jane. During the winter—to compensate for her SAD—she tries to be as productive as possible in the limited number of hours each day in which she's able to function near full capacity.

Like others enduring SAD, Jane craves starches and sweets in winter, and says her culprits are “any kind of bread, cake, donuts. But I do try to avoid drinking too much alcohol.” While Jane has been successful in controlling her weight, many victims of SAD put on excess pounds during the winter, which further contributes to their cycles of low self-esteem.

beating deep depression
Those diagnosed with SAD may lose interest in sex and other once-passionate pursuits and hobbies. Ultimately they can grow indifferent to close friends and family members—even life itself. It happened to Jane in 1993.

She had grown up near Charleston, South Carolina, and always fancied herself a child of the sun, spending summers as a teen working in a nearby island's surf shop. Jane even attended college in New Mexico, “as much for the climate as anything.”

And while she often suffered from the winter blues as an adolescent, it wasn't until she relocated to Boston as a young woman that SAD manifested itself with a vengeance.

During her first winter in New England, Jane found herself growing increasingly lethargic and negative—about her work, her relationships and herself. “It just got worse and worse until I was in bed for two weeks, and people from work came looking for me,” she recalls. “I was suicidal.” This episode and its aftermath led to five years of antidepressants, including Prozac and Zoloft. Jane says the medications helped dramatically, and—since her move to Atlanta the following year—her SAD largely has been under control.

natural options
While the severity of Jane's symptoms led her doctor directly to the prescription pad, light therapy increasingly is the preferred first-line treatment for SAD. For up to a few hours each day in their homes, patients sit close to specially made light boxes that produce fluorescent light as much as 20 times brighter than ordinary indoor lighting.

Rosenthal urges patients to use commercially manufactured light boxes rather than homemade contraptions because the commercial boxes are designed to treat SAD using specific light intensities and durations.

You can use the boxes while eating, reading or watching TV—and even sleeping, in the case of dawn simulators, which increase light intensity on timers to mimic a bright summer morning. Light visors, which are worn like caps and provide patients with increased portability, are another available source of light therapy.

While studies show that up to 80 percent of SAD patients respond quickly and well to light therapy, the benefits usually are soon lost if the therapy is discontinued.

Rosenthal also believes some patients may benefit from the herb St. John's wort. “It's just one of many options,” he says. “I think it can help people, although they should be careful about combining St. John's wort and light therapy.” The herbal remedy can sensitize the eyes, and patients could develop eyestrain and headaches. But as St. John's wort isn't right for everyone, Rosenthal cautions that patients should check with a health care practitioner before using the herb or any other alternative remedies.

Diet, exercise, counseling and stress management also can help alleviate the symptoms associated with SAD and other depressive disorders, experts say. Taking a walk outside during your lunch break can be a big help, even when skies are overcast.

Those are some of the ways Jane has been able to manage her SAD in recent years. “I'm definitely more conscious now,” she says. “I just try to exercise, stay positive and get outside as much as I can during the day.”

Since even Atlanta can get dreary in the winter, she's planning a trip to the Florida Keys this month. Vacations to sunny locales are, in fact, one of the ways doctors suggest patients cope with SAD. But for Jane, a child of the sun, her trip may be just the beginning.

“Sometimes I sit around at work and think about which places have the most daylight year-round,” she says. “Depending on how bad this winter gets, I may really start looking into it.”

St. John's wort
While several potential new treatments for seasonal affective disorder (SAD) are currently being researched, St. John's wort has the longest track record of the available alternative remedies. But it may not be right for you: Talk to a health care practitioner before trying it.

what is it? St. John's wort (Hypericum perforatum) is a perennial yellow-flowering plant that has been among the most-prescribed European remedies for depression for many years. In the United States, the herb is considered an over-the-counter dietary supplement and isn't regulated as a drug by the federal government.

does it work? St. John's wort appears to provide some relief for people suffering mild to moderate depression, including seasonal affective disorder. Also, side effects generally are milder than those of prescription antidepressants, and may include constipation and bloating. While St. John's wort may take about two weeks to relieve symptoms, not all commercially available preparations are identical in dosage size and strength.

can I take it? Ask your health care practitioner. St. John's wort should not be used if you're taking antide-pressants or medicines for an organ transplant, AIDS or other immune system conditions. St. John's wort may also cause increased eye and skin sensitivity to light, which may interfere with light therapy for SAD in the winter and increase the risk of sunburn in the summer.

how should I take it? St. John's wort is available in a variety of liquid, solid, powder and capsule forms. Use it according to the directions on the product label. Look for brands containing standardized, same-sized doses that guarantee the potency of the herb.

don't be SAD
If you think you have seasonal affective disorder (SAD) or another form of depression, see your health care practitioner. The following resources also may help you understand and overcome SAD.

books
Visit your local library, bookstore or online retailer for these SAD-specific titles:

Winter Blues: Seasonal Affective Disorder—What It Is and How to Overcome It, by Norman E. Rosenthal, MD
Seasonal Affective Disorder and Beyond: Light Treatment for SAD and Non-SAD Conditions, by Raymond W. Lam
Don't Be SAD: Fight the Winter Blues-Your Guide to Conquering Seasonal Affective Disorder, by Celeste A. Peters
web sites
For more specialized information and support:

National Association for the Mentally Ill: nami.org
National Institute of Mental Health: nimh.nih.gov
National Mental Health Association: nmha.org
National Organization for Seasonal Affective Disorder: nosad.org
For information on light therapy products and research:

The Circadian Lighting Association: claorg.org
The Society for Light Treatment and Biological Rhythms: sltbr.org
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By Rob Morano

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