The SAD Season

One woman’s journey into the light



The first winter I lived in Maryland, I rarely left my bed.

It was 2006, and my husband, Ron, and I had recently moved to Gaithersburg from Santa Monica, Calif. Uprooting our lives had been more difficult than I’d anticipated, and I spent hours fused to my sheets. I dozed. I cried. But mostly I laid flat on my back and stared at the ceiling.

I missed California’s sun and warmth; Maryland was cold and gray.

In Santa Monica, I had bounded out of bed each day, eager to walk along the beach before getting to work. Now it took hours for me to muster enough energy to propel myself into the shower, and then down the hall to my home office.

Though ashamed of my sluggish behavior, I had a good excuse. In addition to feeling homesick, I had suffered a miscarriage three weeks after the New Year. The loss had been hard.

So I didn’t think much about the fact that I continued to nibble graham crackers in bed long after morning sickness was no longer an issue.

A February escape to Mexico helped. As I soaked up the rays, ocean waves lapping at my feet, my sadness subsided. A warm breeze lifted the weight from my chest.

When I returned home, cherry blossoms were swirling. Color had returned to the world.

I dismissed my seasonal depression as an anomaly. Then winter was back, and my symptoms were, too.

By my third winter, one thing was clear: There was a pattern to my depression, and that pattern perfectly described seasonal affective disorder (SAD).

First identified in the early 1980s by researchers at the National Institute of Mental Health (NIMH) in Bethesda, SAD affects as many as 35 million Americans, according to Mental Health America, a nonprofit organization that promotes mental wellness.

Rockville’s Dr. Norman Rosenthal, a clinical professor of psychiatry at Georgetown University Medical Center, led the NIMH team that identified SAD after realizing he suffered from it himself. He wrote a book about the disorder, Winter Blues (Guilford Press, 1993), and, in fact, it’s “winter blues”—the milder form of SAD—that some 14 percent of the U.S. population experience. But for 6 percent of the population, the symptoms can be debilitating: hypersomnia, social withdrawal, loss of interest in activities, weight gain, change in appetite (especially a craving for carbohydrate-rich foods like my graham crackers) and sadness.

They’re the same symptoms as depression, but the distinguishing factor is the cycle of seasonality: The episodes regularly occur during the fall and winter and resolve during the spring and summer. (For a small number of people the reverse is true: Summer is the depressive season.)

In its most pronounced form, SAD can lead to hospitalization or suicidal thoughts, says Dr. Kristina Deligiannidis, medical director of the Depression Specialty Clinic at the University of  Massachusetts Medical School in Worcester, Mass.

 

Illustration by Ellen ByrneNeal Owens, who recently moved from North Bethesda to Thurmont, Md., began struggling with the winter blues when he was in high school in Wheaton. But it wasn’t until he was an adult and working as a sales representative for a petroleum company that he began to notice the pattern: He was a top producer in the spring and summer, but operated at half-speed in the fall and winter.

Owens struggled to get out of bed and gained 15 pounds from eating carbs and junk food. His doctor ruled out mono, thyroid disorder and vitamin deficiencies. Only then was he diagnosed with SAD.

Beth, a Gaithersburg resident who asked to be identified only by her middle name, similarly noticed a change in her productivity each winter. She’d spent part of her childhood in the South Pacific before moving to Boston, then to Chicago and finally to Maryland in 1991. “I noticed the lack of light even as a young person,” she recalls. She would “leap around” like a grasshopper during the summer, then come to a screeching halt in the winter. Eventually she, too, was diagnosed with SAD.

Dr. Robert Hedaya, a clinical professor of psychiatry at Georgetown University Medical Center, says the depressive cycle must occur at least two years in a row before it can be diagnosed. Typically, the diagnosis is made by an internist, family practitioner or psychiatrist. (Rosenthal’s book includes a questionnaire for self-diagnosis.)

SAD affects four times as many women as men—perhaps because of cyclical hormones, Rosenthal says. And it’s more common in northern latitudes. Population surveys published in Psychiatry Research show that nearly 10 percent of people in New Hampshire have reported symptoms of SAD, compared with just over 6 percent in Maryland and less than 1.5 percent in Florida. A 2009 Centers for Disease Control and Prevention survey found that people who live in sunnier climates tend to be happier than those who don’t.

Relocating to a geographical location farther from the equator is a common trigger for SAD, Rosenthal says. Beth had left the South Pacific. And I had moved from a place that’s sunny 73 percent of the time to one that’s sunny just 56 percent of the time.

Age is also a trigger. Although it can occur in kids, SAD usually starts between the ages of 20 and 40, with women in their late 30s most at risk, according to a 1989 NIMH study. I was 32 when we moved.

Herb Kern, a scientist working at Bell Laboratories in Florham Park, N.J., was among the first to suspect that changes in environmental light might impact mood. He noticed that his own frame of mind improved as the days lengthened. Studies since have shown that light therapy—sitting in front of a light box that mimics sunlight—is one of the most effective remedies for SAD, helping up to 80 percent of those affected by the disorder. And although endorphin-boosting exercise and transcendental meditation also have been shown to alleviate major depression, light therapy remains the treatment of choice for SAD. Deligiannidis recommends 30 minutes to two hours each day, depending on the person.

Owens participated in one of the first clinical studies of light therapy in the early ’80s after hearing about Rosenthal’s work at NIMH. He was ordered to sit in front of a light box at home for two hours each morning and each night. “It turned my life around,” he says.

His productivity skyrocketed that winter—that is, until the light box was taken away. “Within three days, I went into a nosedive,” he says.

He constructed a light box himself, and today is president of The SunBox Company in Gaithersburg, one of two area companies to sell the product; the other is BioBrite in Bethesda. (SunBox also sells visors that SAD sufferers can wear during the day, though they’re less popular, perhaps because of the fashion statement they make.)

Beth is among Owens’ customers. She uses the company’s SunSquare+ box, its brightest and largest unit at $525. She also uses a dawn simulator, which sells for $129.95 and mimics the light of sunrise.

Experts aren’t sure why light deprivation plays a key role in SAD, “but there are some very good clues,” Rosenthal says. One is that people with SAD secrete too much melatonin, a neurotransmitter that plays a role in controlling the body’s circadian rhythm, or internal body clock. “When light comes into the eye it hits retinal ganglion cells, receptors that are distinct from rods and cones,” Hedaya explains. “Those receptors change the light into a signal that [suppresses] melatonin.”

People with SAD might process light differently—meaning they need more light during winter’s long, dark days in order to make less melatonin.

 

Another possibility is that SAD patients have lower levels of serotonin—a neurotransmitter believed to influence mood—during the winter months. “Carbohydrate-rich meals can boost levels of brain serotonin,” Rosenthal writes in his book. “That may be why people with SAD are so inexorably driven to gorge on sweets and starches in the winter.”

Some doctors prescribe selective serotonin reuptake inhibitors (SSRIs) to treat SAD. And in 2006, the U.S. Food and Drug Administration approved Wellbutrin for the disorder.

Wellbutrin is not an SSRI, but rather affects dopamine, another neurotransmitter implicated in SAD, Rosenthal says.

Seeking treatment early is key, says Dr. Michael Horan, a Kensington-based psychiatrist and chief of psychiatry at the Mid-Atlantic Permanente Medical Group. Horan starts seeing SAD patients as early as August, before symptoms kick in, and continues seeing them through the winter. “Treatment is ongoing and can include medication management, psychotherapy and light therapy, as appropriate for each individual case,” Horan says.

Beth tried many classes of psychotropic medication over the years, but didn’t respond well. Talk therapy helps, however, and she sees Rosenthal once a month throughout the year.

She feels more herself with the light treatment, but notices diminishing results as the season wears on. She visits her sister in California to get away—SAD experts recommend taking sunny vacations—but she continues to seek ways to survive the winters here.

The disorder never goes away. SAD sufferers learn to cope—or move to sunnier climes.

During my third winter here I borrowed a light box from one of my husband’s colleagues. At four pounds, it was bulky—a 14.5-by-7-by-6-inch triangular box shaped like a Toblerone candy bar. I was skeptical that it would help. But I plugged it into a socket in my home office and within days felt more buoyant.

I also replaced all the lightbulbs in our house with a higher wattage (something SAD experts recommend, along with finding a house with big windows). It made me feel better, but it bugged my eco-friendly husband. I asked him which was more important: a smaller carbon footprint or a happy, healthier wife. He chose the latter, but like many people remains skeptical that SAD even exists. Everyone slows down and gains a little weight in the winter, right? Of course, those of us who drag through January and February know the disorder is all too real.

This season marks my sixth winter here, and I have a new light box for my desk. Rosenthal suggested I buy three more—a dawn simulator, the SunSquare+ and a lamp for our breakfast table—but I’m trying to avoid having my town house look like a hospital.

I take vitamin D supplements, even though studies linking vitamin D deficiencies to SAD are inconclusive.

I have a personal trainer during the winter months to keep my exercise habits on track. And I’m working at embracing the season. I collect all things fluffy—hats, mittens, boots—and

I’ve perfected a spiced apple cider recipe. Still, I’m looking forward to the day when I can trade my fuzzy Merrells for flip-flops. Because as far as I can tell, nothing beats a beautiful, sunny day.

SAD Symptoms

For most people who contend with seasonal affective disorder (SAD), symptoms manifest themselves in fall and winter. (A smaller number experience SAD in spring and summer, with slight variations in symptoms.) The symptoms must be observed at least two years in a row before the disorder can be diagnosed, and might include:

  • 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

Source: www.mayoclinic.com

Jenny Rough is a freelance writer and sun worshiper. She lives in Alexandria, Va. To comment on this story, email comments@bethesdamagazine.com

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