There seem to be two distinct seasons here in Seattle. There is the shorter one, where everyone is outside and enjoying our beautiful temperate, sunny and not-too-humid weather. And then there is a much longer period where people tend to hibernate a little more, sheltering themselves from the cold, wet and dark elements. For those who experience “winter depression” or Seasonal Affective Disorder (SAD), this can be a much more difficult time.
SAD is best known for its fall-onset pattern, in which symptoms begin in late fall and last until spring. (Interestingly, there is a spring-onset pattern, but the symptoms differ.) More common in higher northern latitudes (like Seattle) and in women, SAD is thought to be caused by a decrease in exposure to natural sunlight, which leads to decreased levels of serotonin in the brain. So people who feel just fine during sunnier months can feel down during the remainder of the year. Those who have SAD tend to sleep more, have an increased appetite (especially for carbohydrates), be irritable, gain weight, have a sensation of heaviness in the arms or legs, and have trouble with interpersonal relationships.
Mild SAD can improve significantly with light therapy, which involves sitting for a specified period of time about two feet from a light box that emits 2,500-10,000 lux of light at eye level. Though light boxes are available commercially, you should not purchase one until you’ve discussed with your doctor whether it is appropriate for you. Certain people (like those with bipolar disorder or psychosis) can have adverse effects from light therapy. Antidepressant medications called Selective Serotonin Reuptake Inhibitors (SSRIs) are often used when SAD symptoms are moderate or severe. They can also prevent recurrence in people who have an established history of recurrent SAD when used earlier in the fall season.
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If you have a tendency to feel a little down in the winter and your doctor does not feel your symptoms require a specific therapy, it may be helpful to take some other simple steps to improve your mood.
• Schedule social activities throughout the season or take a vacation to a sunny locale.
• Use a dawn simulator, a device that gradually increases the light in the bedroom in the early-morning hours to help you wake up more naturally.
• Avoid the temptation of carbohydrate-laden “comfort foods.” The quick spike and drop in glucose can affect mood and energy levels.
• Get outside and walk during the day as much as you can.
• Connect your lamp to a timer that turns the light on in the early morning before the sun comes out.
• Avoid tanning beds, which increase the risk of skin cancer.
• Always remember: call 911 or 1-800-273-TALK if you are feeling suicidal.
Fall is officially here in Seattle. Talk to your doctor if you feel you might have symptoms of SAD. She will try to help you stay active, healthy and happy while patiently waiting for clear, blue-sky days to return.
Linda Pourmassina, M.D., is an internal-medicine physician who practices at The Polyclinic in Seattle. She has a blog at pulsus.wordpress.com and can also be found on Facebook and on Twitter @LindaP_MD