What Can Be Done For Seasonal Affective Disorder?

I live in Seattle and am surrounded by gloom nine months out of the year. I have been diagnosed with clinical depression and have been taking Zoloft and Nortripiline for the last ten years. I also suffer from Seasonal Affective Disorder (SAD). Can you tell me what else I can do to get through this? My family and my career are here, and it’s not feasible for me to move.

Seasonal Affective Disorder (SAD) is a mood disorder characterized by the onset of symptoms of major depression during the winter months. Often, the symptoms of depression have some “atypical” features, which means that instead of a person developing insomnia, they start to sleep too much, and instead of a person losing their appetite, they start to eat too much. Some people joke that it’s like a bad case of “hibernation.” Along with these findings, individuals describe a depressed mood, sense of hopelessness about the future, loss of energy, feelings of guilt and anxiety, and even suicidal thinking. Many people report an unusually high craving for carbohydrates during this period.

Most researchers believe that SAD is related to the fact that, in the fall, the days grow shorter and we spend more of our waking hours in darkness or artificial light. This probably affects aspects of our daily circadian rhythms, which in turn are tied in to our mood state in ways that we do not fully understand. Most people with SAD start to feel better as soon as the days grow longer again, towards the end of winter.

A successful treatment of SAD is “light therapy.” You can purchase specially designed light boxes which deliver a bright light similar to the spectrum of light delivered by the sun. You must sit in front of the light box for 2-4 hours per day during the winter months (many people put them near their desk). People with SAD usually obtain a great deal of relief from their symptoms when they use a light box. If you would like to try light therapy, you should do so in consultation with your psychiatrist. He or she can help you find a reputable manufacturer of light boxes, and can help you monitor your progress. In a small number of people, the light therapy can trigger a manic episode.

In my clinical experience, many people with major depressive disorder experience a seasonal component to their depression symptoms, even when they do not meet full diagnostic criteria for SAD. Here are some useful tips for reducing the severity of your winter depressive symptoms (which can be especially severe if you live in a place like Seattle where the short daylight hours are exacerbated by the cloudy weather):

1. Be aware ahead of time that winter is a vulnerable period for you. Prepare for a period of several months in which you may react to stressful events with less resilience than usual and in which your mood will be more fragile.

2. With this in mind, take steps ahead of time to reduce the stressors in your life during the winter months (as much as is feasible). Stick to a regular sleep-wake schedule. Do not overschedule yourself with obligations at work or at home. Give yourself permission to say “no” to demands on your time and energy. Find ways to slow down and to take breaks during the day, to do less on weekends. Is there a work function or a family gathering that you know will push all of your buttons? Skip it. Try to find ways to celebrate the holidays in a lower key, with less fuss and less hype than usual.

3. Maintain sensible nutrition. Eat breakfast, lunch, and dinner. Eat healthy foods that give you energy and stamina. Enjoy fruits and vegetables.

4. Try supplementing your diet with omega-3 essential fatty acids. Some well-conducted research has shown these to be effective in the depression associated with bipolar disorder, and there is anecdotal evidence that it is helpful in mild depression and for some people with a seasonal component to their depressions. Flax seed oil and fish oil are good sources for omega-3 EFAs, with fish oil being in a form that is more readily available. A reputable source is “Omega-Brite” available over the Internet.

5. Make absolutely sure that you have a regular schedule for exercise and that you stick to it religiously. Regular, moderate, aerobic exercise is the best antidote to seasonal mood symptoms.

The information provided on Health Search Online is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment.