The sun also rises: SAD is real--and treatable

[Guest guest]

The sun also rises: seasonal affective disorder is real--and treatable

Source: Better Nutrition magazine, Jan, 2003, by Rob Morano

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 ton, 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. '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. 's wort and light

therapy. " The herbal remedy can sensitize the eyes, and patients could

develop eyestrain and headaches. But as St. '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. 's wort

While several potential new treatments for seasonal affective disorder (SAD)

are currently being researched, St. '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. '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. '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. '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. 's wort should not be

used if you're taking antidepressants or medicines for, an organ transplant,

AIDS or other immune system conditions. St. 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. '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 W. Lam

* Don't Be SAD: Fight the Winter Blues--Your Guide to Conquering Seasonal

Affective Disorder, by Celeste A. s

Websites

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