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For many people, the beauty of fall is mixed with feelings of lethargy, as the days become noticeably shorter, and Seasonal Affective Disorder (SAD) begins. When we turn the clocks back on Nov. 5, this should only intensify.
SAD is caused by the lack of daylight in northern climates during winter. It peaks in late January or February, but some people feel it most right about now. In fact, some experience SAD earlier every year. I think this is because they start to anticipate its arrival, and become more sensitive to the changes in daylight each year.
At this time in the season, I see a lot of patients who are oversleeping and experiencing fatigue and cravings for carbohydrates such as sweets, pasta and bread — especially women. These physical symptoms set in first. Then, often starting around the end-of-year holidays, sad mood starts to be a problem as well.
It’s tough to know how much holiday stress plays into worsening symptoms because the shortest day of the year, Dec. 21, is right around that time. Some have suggested that the third week in January is the absolute worst, due to the combination of cumulative environmental light deprivation and psychological factors. Some people feel a post-holiday slump — and by the end of January, those New Year’s resolutions have often been broken. However in large population studies, most patients say February is worst.
SAD affects 3 to 5 per cent of Canadians, more women than men — and particularly women of childbearing age. Based on the latter, we’re now doing a research project to look at how the symptoms of SAD could affect pregnant women taking part in the Ontario Birth Study at Mount Sinai Hospital. Learning whether SAD symptoms in pregnancy affect infant development later on will be part of this.
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A common explanation for SAD is that it’s a form of hibernation, left over from our cave-dwelling days. This explains the carb cravings, overeating and feeling of lethargy — all help to conserve energy. The theory doesn’t explain why depression occurs, but it’s possible that depression is the result of the hibernation itself — lack of socialization and exercise, and increased junk food.
A more direct biological explanation for SAD is that the cumulative lack of daylight leads to under-stimulation of our brains. This makes sense because we all know light gets us going in the mornings, and darkness makes us sleepy. Too little stimulation to the brain leads to executive functioning problems such as poorer memory and decision making. When the brain is properly stimulated, we tend to eat less, move more and think more clearly.
As well, research shows many people with SAD have a delayed circadian rhythm — they fall asleep and wake up too late. As the days get shorter, these folks may not be able to adjust to the time changes as easily as others.
No matter which theory is correct, the solution for SAD is the same. Light therapy works well to treat the symptoms of SAD, and is by far the preferred treatment. It’s simple: you sit next to an ultraviolet-filtered lamp designed for SAD for 30 minutes a day. Please only use a unit that has been created with UV-filters for the treatment of SAD. You may need to give it two weeks for the treatment to work, but it is successful in two-thirds of people. The lamps can be ordered online, but again, you must make sure you’re buying a lamp designed for SAD (unfiltered ultraviolet light can damage your eyes).
Canadian researchers have found that anti-depressant SSRI medications work as well as light. Doctors sometimes add a supplement called tryptophan to the light therapy, or some people try the supplement on its own. This amino acid boosts serotonin, a chemical in our bodies that is highly associated with happiness and well-being.
Most people feel a touch of the winter blues, but if you’re not functioning as well as you should, or it’s tough to get through the day, or your relationships are suffering, those are red flags suggesting you should be evaluated for SAD. Your family doctor should be able to diagnose and treat you.
Dr. Robert Levitan is a professor of psychiatry and physiology and the Cameron Parker Holcombe Wilson Chair in Depression Studies at the University of Toronto’s Faculty of Medicine. He is also a clinician-scientist in the Campbell Family Research Institute at the Centre for Addiction and Mental Health (CAMH). Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine.