Healthy Habits: SAD

The clocks “fall back” November 1, 2015 which means that there will be less day light. Many people chalk up feeling blue in winter as simply a fact of cold weather and lack of sunshine. But 4 to 6 percent of people may have a winter depression which is clinically referred to as Seasonal Affective Disorder.  Another 10 to 20 percent may have mild SAD. SAD is four times more common in women than in men. Although some children and teenagers get SAD, it usually doesn't start in people younger than age 20. Your chance of getting SAD goes down as you get older. SAD is also more common the farther north you go. For example, it's seven times more common in Washington State than in Florida. Dr. Sanam Hafeez is a neuro-Psychologist in NYC (Manhattan and Forest Hills, Queens), and treats patients in her practice who display and express mood changes once October rolls around. 

Dr. Hafeez explains that, “In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, some people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.” 

The following are symptoms to look for to see if you are suffering from SAD

Depression

Hopelessness

Anxiety

Loss of energy
Heavy, "leaden" feeling in the arms or legs

Social withdrawal

Oversleeping

Loss of interest in activities you once enjoyed

Appetite changes, especially a craving for foods high in carbohydrates

Weight gain

Difficulty concentrating

How is SAD treated?

Many people with SAD will find that their symptoms respond to a very specific treatment called bright light therapy. For people who are not severely depressed and are unable—or unwilling—to use antidepressant medications, light therapy may be the best initial treatment option says Dr. Hafeez.

Light therapy consists of regular, daily exposure to a “light box,” which artificially simulates high-intensity sunlight. Practically, this means that a person will spend approximately 30 minutes sitting in front of this device shortly after they awaken in the morning. If patients do not improve, a second exposure of 20-30 minutes may be added in the early afternoon.  Treatment usually continues from the time of year that a person’s symptoms begin, such as in fall, on a daily basis throughout the winter months. Because light boxes are created to provide a specific type of light, they are expensive and may not be covered by insurance. Unfortunately, having lots of lamps in one’s house and spending extra time outside is not as effective as this more expensive treatment.

Dr. Hafeez states that, “Side effects of light therapy are uncommon and usually reversible when the intensity of light therapy is decreased. The most commonly experienced side effects include irritability, eyestrain, headaches, nausea and fatigue.”

Scientific studies have shown light therapy to be very effective when compared to placebo and as effective as antidepressants in many cases of non-severe SAD. Light therapy may also work faster than antidepressants for some people with notable effects beginning with in a few days of starting treatment. Other people may find that it takes a few weeks for light therapy to work, which can also be the case for most people who take antidepressant medications. Although not explicitly recommended, some people may elect for treatment with both light therapy and antidepressant medications.  The combination of these treatments may be synergistic and a more robust way to address the symptoms of SAD.

In her practice Dr. Hafeez has found that antidepressant medications have been useful in treating people with SAD. Of the antidepressants, fluoxetine (Prozac) and bupropion (Wellbutrin) have been studied in the treatment of SAD and shown to be effective. The U.S. Food and Drug Administration (FDA) has approved these medications for treatment of major depressive disorder.  Dr. Hafeez cautions that, “Any person considering treatment with an antidepressant medication should discuss the benefits and risks of treatment with their doctors.”

Individuals with a predisposition to bipolar disorder should be more cautious in approaching treatment for SAD and depression in general. Light therapy, like antidepressant therapy has been associated with increased risk of experiencing a manic episode. The specifics of this are beyond the scope of this review and again, should be discussed with one’s doctors.

Finally, a healthy lifestyle, including regular exercise, a good diet and a strong social network, is also likely to help you cope with SAD.

Dr. Sanam Hafeez is a New York City based Neuropsychologist and School Psychologist.  She is also the founder and director of Comprehensive Consultation Psychological Services, P.C.  She is currently a teaching faculty member at Columbia University.

Dr. Hafeez’s provides neuropsychological educational and developmental evaluations in her practice.  She also works with children and adults who suffer from post traumatic stress disorder (PTSD), learning disabilities, autism, attention and memory problems, trauma and brain injury, abuse, childhood development and psychopathology (bipolar, schizophrenia, depression, anxiety, etc…) In addition, Dr. Hafeez serves as a medical expert and expert witness by providing full evaluations and witness testimony to law firms and courts.