January 4, 2011 in Features

There are plenty of treatments for those suffering from SAD

Dr. Alisa Hideg
 

You made it through another holiday season. Now you can relax and enjoy the rest of the winter, unless you are part of the 4 percent to 6 percent of Americans suffering from Seasonal Affective Disorder.

Symptoms include sleeping longer, feeling tired, anxiety or sadness, losing interest in activities you usually enjoy, craving carbohydrates and weight gain.

Sure, everyone tires of shorter days and many of us gain weight attending holiday parties and dinners. Does that mean everyone has SAD every winter?

People with the disorder have symptoms that are severe enough to interfere with normal daily life. A person with SAD may need all of her willpower to get out of bed or to go to work each morning. On the weekends, she might not get up at all unless there are things that cannot be skipped like walking the dog or feeding the kids.

I have a friend with SAD and after a few cloudy winter days he is in a terrible mood, walking around with his head down and unpleasant to be around. He is lucky he lives in San Diego; I think the shorter winter days here would be his undoing.

There are many theories on the causes of SAD and there are several ways to make it better without moving south. Light therapy, supplements, exercise and medications are the most commonly recommended treatments.

We will start with light. Your skin and eyes both respond to light. Skin makes vitamin D when exposed to ultraviolet rays in sunlight and then your kidneys change it to a usable form that your body stores.

Retinas, the tissue in the back of your eyes, have receptors that process not only how much light you see, but also what wavelength (or color) the light is. These receptors affect hormones that help your brain set a sleeping and waking cycle.

Most indoor light is weaker and does not have all the wavelengths of sunlight and so does not affect you the way sunshine does.

Light therapy is often suggested for SAD treatment. For many years, very bight, full-spectrum lights have been used, but recent studies suggest that less bright, blue or green lights of a particular wavelength are just as effective. These are typically made with LED lights and are often less expensive than full-spectrum lights.

Talk with your healthcare provider about what to use and for how long. Usually 15 to 30 minutes daily in the morning is effective.

Vitamin D supplements are also recommended. Daily winter dosages can range from 2,000 IU to 4,000 IU, depending on the person. Getting your vitamin D level checked helps with planning treatment.

Melatonin, which helps regulate your sleep and wake cycles, may also play a role in SAD. A 2006 study of people with SAD whose body rhythms were out of sync with the sun showed that properly timed daily melatonin supplements and exposure to bright light in the morning helped improve their symptoms.

Regular exercise, especially in bright light (if it is too cold outside, exercise near a window that lets in plenty of sunlight), can help lessen the symptoms of SAD. For some people evening exercise disrupts sleep, so try exercising in the morning.

In 2006 the FDA approved bupropion as a treatment for SAD. Fluoxetine, sertraline, and other selective serotonin reuptake inhibitor (SSRI) antidepressants are being studied to see if they help.

If you suffer from SAD, should you take vitamin D or melatonin? Sit in front of a special light each morning? Or exercise by a window?

You should probably visit your health care provider first. There are other health problems that may need to be ruled out first.

Things he or she will want to know about besides your symptoms include whether you have been depressed in the same season before and if you improved when the season changed, and whether you have a close relative (parent or sibling) with SAD.

There are still some shorter days left, but the hours of sunlight are slowly increasing again. If you or someone you know has symptoms of SAD, treating it can make these days seem brighter and may even make it possible to enjoy the rest of winter.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section. Send your questions and comments to drhideg@ghc.org.

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