By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER’S “WINTERTIME BLUES” MAY BE DUE TO LESS SUNLIGHT EXPOSURE

Question: Winter is coming and I find I get depressed. This seems to start with me in mid to late October, but doesn’t go away until spring. My mom says it is normal to get “blue” around the holidays and says I should just ignore my feelings. I am 23 now and this seems to happen every year. I am fine the rest of the year, then this happens in the fall. Any thoughts on what I should do?

Answer: As a mother of four, I don’t like to say that mom is maybe not giving you the right advice, but this time I think you shouldn’t listen to her. You have described something called seasonal affective disorder (SAD). Typically, those with this condition say their symptoms start in October, peak in January or February, and then start to wane. They are usually symptom free in the spring and summer months.

SAD suffers are very sensitive to the decrease in daylight hours. Why some people have this sensitivity is not very clear. There is some speculation that their brains increase melatonin production at the wrong time of the day due to both the shorter days and the decrease in sunlight intensity.

In the winter months, according to one theory, a SAD sufferer’s body will produce “stay awake” substances -- like the hormone cortisol and certain neurotransmitters -- until the early morning hours. Then, after he or she stays awake half the night, the body finally increases production of sleep-inducing melatonin. This production, though, continues until midday, so the sufferer has trouble getting out of bed until 10 or later. In short, the person’s biological clock, or circadian rhythm, is “all messed up.” There is a good deal of research showing that circadian rhythm disruption is linked to depression.

Typically people with SAD only have episodes of depression during the months when they get less light exposure. This sounds like the situation you describe. And, you also seem to meet the criteria of having these symptoms for at least two years in a row. SAD and the “holiday blues” are not related.

To be diagnosed with SAD, or any type of depression, the symptoms must last longer than two weeks, significantly interfere with your work or social life, and not be due to another underlying medical condition or drugs or alcohol.

The most common symptoms are depressed mood and a reduction in pleasure or interest in most or all activities. Sleep disturbances -- either too much or too little -- are common to all types of depression. People with SAD often say they are sleeping more, but it’s not clear if this is actually the case. Other possible symptoms include change in appetite or weight, fatigue or loss of energy, feelings of worthlessness, diminished ability to concentrate, recurrent thoughts of death, and in severe cases suicidal thoughts.

The good news is that with a proper diagnosis, you can get the right treatment. Many SAD sufferers respond to therapy with bright or full-spectrum light that helps reset their biological clock and control melatonin production. Some people are able to help themselves by just getting outside in the bright winter sun for about an hour each day. Also, a new medication was approved in June for treatment of SAD. Some people need medication starting in September until the winter is over. To diagnose your condition and determine the best treatment, I’d recommend you see a family physician.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.