LIFE
SAD suffering grows as seasons change | Toronto Star
By: Dr. Robert Levitan, University of Toronto, Published on Tue Nov 11 2014
SAD is different from most other kinds of depression: its symptoms are a lot like hibernation. Every year, as the days get longer and falling leaves turn to falling snow, nearly one in five Canadians suffers from seasonal mood change.
The most famous example is Seasonal Affective Disorder (SAD). SAD is different from most other kinds of depression: its symptoms are a lot like hibernation. People sleep much more than usual, eat more, gain weight and withdraw socially. I see SAD as a leftover from the Ice Age, when people needed to conserve energy. In modern times, SAD is counterproductive on many levels. Sufferers most commonly complain about the weight gain, the isolation and the depression that goes with it.
Three out of four SAD sufferers are female, and interestingly, people born in the spring with a particular genetic background seem more vulnerable to it. Typically, SAD starts about now — when the clocks have changed and the days are getting shorter. The holidays, which arrive just after the shortest day of the year, and come with additional stress, only heighten symptoms. January and February are the pinnacle of SAD. Then, when the clocks go back again and the days get longer, SAD goes away.
Many people experience a touch of winter blues, but SAD is different. You should get help when your ability to function starts to decline, if you have trouble with your normal routine at work or home, you can’t get through the day like you used to, your relationships are strained because of low energy or if you’re irritable and depressed. If any of this sounds familiar, most family doctors are comfortable diagnosing and treating SAD. If necessary, a specialized light therapy clinic can help. Ask your doctor for a referral.
The good news is that treatment is user friendly and it usually works. Light therapy — which involves exposure to specific types of light — is very effective. Two-thirds of patients find it makes a real difference — and, for some reason, the people who have the most success are those driven to overeat or who crave carbs during the winter.
Before starting treatment, it’s very important to get both your doctor’s advice and the right equipment. For example, just using an ordinary UV light on yourself is very dangerous — you could do real damage to your eyes.
Only use commercially available units that have been tested and are UV filtered for the treatment of SAD. There are several suppliers who will ship you a light in 24 to 48 hours. You will need to expose yourself for 30 minutes a day for two weeks to know whether the treatment will work. There are some side effects, such as headache and eye strain. People with bipolar disorder may experience a manic episode. That’s why your family doctor should supervise this treatment.
Doctors also treat SAD with a supplement called tryptophan, which is available by prescription and can be used both alone and together with light therapy. This is an amino acid that boosts serotonin naturally — and there’s significant evidence that serotonin deficiency is the main cause of SAD.
Most patients prefer light treatment, but for those who are strapped for time or can’t tolerate light, research has shown that antidepressants are as effective.
As with so many things, prevention is the best medicine. If this is feasible for you, try to maintain an active schedule and avoid long periods being indoors, socially isolated and inactive. Sleeping too much can promote depression, so get up early if you can, to exercise or just go outside to get some air or take a walk. This will help get your energy up early in the day. But don’t beat yourself up if you can’t do it. See it as a sign that you need treatment.
Getting what natural light you can is good, but it can be challenging during our grey Toronto winters. For office workers, being near a window is very helpful. I’ll often write my patients a letter of support to try to get them a window office with natural light.
It’s also vital to avoid eating a lot of simple sugars — the kind you find in junk food. With winter depression, people want to comfort themselves with junk food, but this promotes sluggishness, weight gain and low mood. Try to replace these carbs with protein, such as a handful of nuts or seeds. Frequent, small meals are another good strategy.
If you suspect that you have SAD, please seek help. Depression is a terrible thing to live with — especially in this day and age, when there are so many treatments available. Just like you would get treatment if you broke a bone or came down with a high fever, get help if you suspect you have SAD.
Dr. Robert Levitan is a professor of psychiatry and physiology and the Cameron Wilson Chair in Depression Studies at the University of Toronto’s Faculty of Medicine. He is also a clinician-scientist 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. If you have a question or comment for one of our experts, email doctorsnotes@thestar.ca .
