The Medical Minute: 'Winter blues' may be serious depression

By Anoop Karippot

"I want to just eat and sleep. I feel so down all the time." This is a common feeling for some who find it a nightmare to survive the winter. Seasonal Affective Disorder (SAD) or “winter blues" is a recurrent form of depression suffered during the fall and winter seasons. When the seasons change with a significant decrease in temperature and daylight, some people tend to eat and sleep more. It appears that some are more sensitive to change in weather, especially to changes in the amount of light, and exhibit an unstable emotional state. These symptoms diminish spontaneously in spring and summer.

The specific cause of SAD remains unknown. It is likely to be multi-factorial. Some researchers have suggested the possibility of a dysfunction in the circadian rhythm or biological clock. Sunlight or bright light inhibits the secretion of melatonin, a hormone secreted from the pineal gland in the brain that regulates the day and night cycle in the human body. Researchers have found patients experiencing SAD have increased secretion of melatonin. Serotonin is a precursor for melatonin, and is implicated in causing major depression.

Genetics, age and location may play roles in seasonal affective disorder. SAD, common in people living in higher latitudes away from the equator, is rarely found in tropical regions.

The most common symptoms of SAD are:

• Depressed mood that begins in fall or winter
• Hypersomnia -- excessive sleeping
• Hyperphagia -- increased appetite and overeating
• Carbohydrate craving -- especially bread and cookies
• Excessive weight gain
• Difficulty in focusing/concentrating
• Anxiety
• Potential substance abuse -- especially with alcohol -- and thoughts of suicide in severe cases

Approximately 25 percent of people in the northern latitudes of the United States experience some form of the disorder. The most difficult months seem to be January and February.

It is possible that some people may show depressive symptoms that worsen during winter or fall. It is important that these people are not misdiagnosed as having SAD. The recurrent pattern of symptoms that occurs only during fall and winter and the lack of symptoms during summer in these people may give a clue to the diagnosis.

Treatment Options

-- Light therapy (Phototherapy): Bright white light is the most effective treatment. Sunlight exposure is the best and cheapest option, if available. Simple steps like a morning walk or activities near a window with morning sun may suffice to treat the depressed mood in some people. In cases where sun light is not possible, artificial bright light therapy can be used.

Light therapy equipment called light boxes are available for treatment of SAD. Bright light therapy is not approved by the U.S. Food and Drug Administration (FDA). When using light therapy, it is important to protect the eyes by wearing dark goggles. Recent studies have indicated that the blue frequency range in the spectrum of white light may be more effective. The timing of light therapy is important. Light therapy should be initiated under the supervision of a trained physician like a sleep specialist or a psychiatrist who has expertise in the area.

-- Medication: The FDA has approved the antidepressant bupropion (Wellbutrin–XL) for the prevention of depressive symptoms in patients with SAD. Other antidepressants like sertaline (Zoloft), fluoxetine (Prozac), venlafaxine (Effexor) have shown promise. Patients should consult their doctors for effective management of these symptoms.

-- Psychotherapy: Supportive therapy and cognitive behavioral therapy targeting the negative thoughts and improving coping skills have helped patients with SAD. Good sleep hygiene practices and a structured environment may help to decrease the severity and frequency of symptoms.

Specialists at Penn State Hershey can diagnose and treat SAD. For information or to schedule a consultation, call (800) 243-1455 or send an e-mail to sleep@psu.edu.

Anoop Karippot is an assistant professor in the Department of Psychiatry at Penn State College of Medicine and a sleep specialist in the Penn State Hershey Sleep Research and Treatment Center.