Neil Wagner grew up in northern Minnesota. For him, the winter blues turned boot black. He couldn’t get out of bed, felt overwhelmed by life and even entertained the idea of suicide. His mother and brother also exhibited symptoms with the onset of fall much darker than the more common winter or holiday blues.
After college, Wagner followed the call of snowcapped mountains and raging rivers to become an Alaskan river pilot. But only during the summer months. He escaped his as yet unnamed, undiagnosed seasonal depression during the fall and winter months by wintering in Australia or the south western U.S
But, Alaska is where Wagner’s soul is. Unfortunately, his SAD symptoms escalated, with the fewer daylight hours of northern winters. And with age and family responsibilities, he doesn’t exercise or spend as much time outside as he used to. He learned about light therapy from a fellow sufferer in Seattle. “These lights let me settle in Alaska,” he said.
As daylight hours become fewer at the end of the year, some people become pathologically sad. This inability to function at work or at home is more than a case of winter blues — it is a mental illness first described as Seasonal Affective Disorder (SAD) in 1984 by Norman Rosenthal and his colleagues at the National Institute of Mental Health.
Doctors agree that it can be difficult to determine who is afflicted with SAD and who is simply depressed and may have the “holiday blues”.
While SAD depression can be minor, severe bouts can lead to job loss, and marked interpersonal difficulties. Conversely, many SAD sufferers report better than average functioning relative to peers in the spring and summer months.
But. not all sad feelings are SAD. The main criterion in diagnosing SAD is that this depression is seasonal — starting between September and January, and disappearing with the longer days of April and May.
However, symptoms of SAD cannot be attributed to seasonal psychosocial stresses, such as Christmas. By definition, SAD occurs earlier in the year.
People with SAD experience fatigue, sadness, difficulty concentrating and hypersomnia, without feeling rested. Coupled with a decrease in physical activity is a craving for carbohydrates (sugar, starches and alcohol) and subsequent weight gain (up to 30 pounds in six months). The sufferer is often overwhelmed, anxious and irritable.
These symptoms can progress to such a degree that the individual may require hospitalization.
“There tends to be an underestimation in terms of debilitating effects,” said Robert Levitan, a psychiatrist at the Centre for Addiction and Mental Health, Clarke Division, in Toronto. “The key is to take this disorder seriously.”
Early diagnosis is important. Patients with SAD often fail to recognize their disorder for many years, until the sufferer becomes significantly disabled.
About 80 per cent of the afflicted are women, between the ages of 18 and 45, although children and men suffer from it too.
SAD typically starts in one’s early 20s, but can start at puberty or later. It appears to be a genetic trait with entire families prone to it.
While the pathophysiology of SAD remains elusive and unconfirmed, recent studies estimate it is more common in northern countries where the winter day gets relatively shorter.
In Florida, less than one per cent of the population is recorded as suffering from SAD, whereas in Alaska as many as 10 per cent may suffer from the condition. However, studies done in Ontario and Europe don’t follow this pattern. In fact, Iceland has a much lower rate than expected for its latitude.
These studies indicate cities with cold, bright winters and those with an active winter culture often have lower rates of SAD than latitude alone would predict. And, cities like Vancouver, with warm, dark winters, have relatively high rates of SAD.
An individual who moves to a climate with higher rates of SAD could face a risk for the disorder at the expected rates for that latitude. And, conversely, for a SAD sufferer going south, the symptoms may go into remission.
At this time a cure is not known, but treatment is available. Levitan said about two-thirds of sufferers’ symptoms are reduced or eliminated by exposure to bright, artificial light called bright light therapy or phototherapy.
Jamie Rifkin, a clinical researcher at the New York State Psychiatric Institute, said studies have been done focusing on investments in light in the mornings and evenings. They found morning light is most effective, because that is when the retina is most sensitive to light.
He warned that continuous exposure could create a potential for side effects. Side effects from light therapy are usually minimal. Some people experience anxiety, jitteriness, eye strain, mild headaches, early awakening and even hypermania. While most of these symptoms disappear within a few days, often they can be avoided by reducing session length or the distance from the light, until the light is better tolerated.
Other ways to minimize the effects of SAD include taking a half hour walk in the early morning, maintaining an active lifestyle and optimizing natural light exposure.
Also, because people with SAD often are tired, psychiatrists recommended sufferers watch their diet and avoid artificial sugars as much as possible.
While exercise can also be beneficial, unfortunately, this is often not possible in more depressed patients who should not be “pushed” to be active.
“While they may not feel as well as a non-sufferer, most people respond quite well to light therapy,” said Levitan. If light therapy is insufficient, doctors consider the drug L-tryptophan, an amino acid and precursor of serotonin that increases brain serotonin levels. When neither neither light therapy or L-tryptophan work, the next step is usually standard antidepressant medication.
The Department of Psychiatry in the the University of Toronto has found the long-term course of SAD to be variable.
How to help employees with SAD
Marnie Downey, of ERGO: Evaluating Risks in Growing Occupations, suggests the following when an employee exhibits symptoms of the winter blahs:
•pay attention to moods and energy levels. If you notice an employee’s spirits sinking in the fall, take preemptive action. A good offence is better than an after-the-fact defence;
•expose the employee to as much bright light as you can, either from a window or a commercially available light box. If it is a sunny day encourage the employee to go out. If it is gray and overcast, use as much light indoors as possible;
•encourage the sufferer to enrol in a stress management program;
•plan active events — organize a ski trip, skating party or a curling bonspiel;
•promote overall good health and encourage employees to be physically active, before the blahs take over;
•encourage the employee to regulate his light intake. Suggest he/she use less light in the evenings to regulate the body’s circadian rhythm; and
•if the employee feels he/she is still sinking, encourage him/her to seek professional help. What the person learns from this season is something he/she can use in the falls and winters to come.
After college, Wagner followed the call of snowcapped mountains and raging rivers to become an Alaskan river pilot. But only during the summer months. He escaped his as yet unnamed, undiagnosed seasonal depression during the fall and winter months by wintering in Australia or the south western U.S
But, Alaska is where Wagner’s soul is. Unfortunately, his SAD symptoms escalated, with the fewer daylight hours of northern winters. And with age and family responsibilities, he doesn’t exercise or spend as much time outside as he used to. He learned about light therapy from a fellow sufferer in Seattle. “These lights let me settle in Alaska,” he said.
As daylight hours become fewer at the end of the year, some people become pathologically sad. This inability to function at work or at home is more than a case of winter blues — it is a mental illness first described as Seasonal Affective Disorder (SAD) in 1984 by Norman Rosenthal and his colleagues at the National Institute of Mental Health.
Doctors agree that it can be difficult to determine who is afflicted with SAD and who is simply depressed and may have the “holiday blues”.
While SAD depression can be minor, severe bouts can lead to job loss, and marked interpersonal difficulties. Conversely, many SAD sufferers report better than average functioning relative to peers in the spring and summer months.
But. not all sad feelings are SAD. The main criterion in diagnosing SAD is that this depression is seasonal — starting between September and January, and disappearing with the longer days of April and May.
However, symptoms of SAD cannot be attributed to seasonal psychosocial stresses, such as Christmas. By definition, SAD occurs earlier in the year.
People with SAD experience fatigue, sadness, difficulty concentrating and hypersomnia, without feeling rested. Coupled with a decrease in physical activity is a craving for carbohydrates (sugar, starches and alcohol) and subsequent weight gain (up to 30 pounds in six months). The sufferer is often overwhelmed, anxious and irritable.
These symptoms can progress to such a degree that the individual may require hospitalization.
“There tends to be an underestimation in terms of debilitating effects,” said Robert Levitan, a psychiatrist at the Centre for Addiction and Mental Health, Clarke Division, in Toronto. “The key is to take this disorder seriously.”
Early diagnosis is important. Patients with SAD often fail to recognize their disorder for many years, until the sufferer becomes significantly disabled.
About 80 per cent of the afflicted are women, between the ages of 18 and 45, although children and men suffer from it too.
SAD typically starts in one’s early 20s, but can start at puberty or later. It appears to be a genetic trait with entire families prone to it.
While the pathophysiology of SAD remains elusive and unconfirmed, recent studies estimate it is more common in northern countries where the winter day gets relatively shorter.
In Florida, less than one per cent of the population is recorded as suffering from SAD, whereas in Alaska as many as 10 per cent may suffer from the condition. However, studies done in Ontario and Europe don’t follow this pattern. In fact, Iceland has a much lower rate than expected for its latitude.
These studies indicate cities with cold, bright winters and those with an active winter culture often have lower rates of SAD than latitude alone would predict. And, cities like Vancouver, with warm, dark winters, have relatively high rates of SAD.
An individual who moves to a climate with higher rates of SAD could face a risk for the disorder at the expected rates for that latitude. And, conversely, for a SAD sufferer going south, the symptoms may go into remission.
At this time a cure is not known, but treatment is available. Levitan said about two-thirds of sufferers’ symptoms are reduced or eliminated by exposure to bright, artificial light called bright light therapy or phototherapy.
Jamie Rifkin, a clinical researcher at the New York State Psychiatric Institute, said studies have been done focusing on investments in light in the mornings and evenings. They found morning light is most effective, because that is when the retina is most sensitive to light.
He warned that continuous exposure could create a potential for side effects. Side effects from light therapy are usually minimal. Some people experience anxiety, jitteriness, eye strain, mild headaches, early awakening and even hypermania. While most of these symptoms disappear within a few days, often they can be avoided by reducing session length or the distance from the light, until the light is better tolerated.
Other ways to minimize the effects of SAD include taking a half hour walk in the early morning, maintaining an active lifestyle and optimizing natural light exposure.
Also, because people with SAD often are tired, psychiatrists recommended sufferers watch their diet and avoid artificial sugars as much as possible.
While exercise can also be beneficial, unfortunately, this is often not possible in more depressed patients who should not be “pushed” to be active.
“While they may not feel as well as a non-sufferer, most people respond quite well to light therapy,” said Levitan. If light therapy is insufficient, doctors consider the drug L-tryptophan, an amino acid and precursor of serotonin that increases brain serotonin levels. When neither neither light therapy or L-tryptophan work, the next step is usually standard antidepressant medication.
The Department of Psychiatry in the the University of Toronto has found the long-term course of SAD to be variable.
How to help employees with SAD
Marnie Downey, of ERGO: Evaluating Risks in Growing Occupations, suggests the following when an employee exhibits symptoms of the winter blahs:
•pay attention to moods and energy levels. If you notice an employee’s spirits sinking in the fall, take preemptive action. A good offence is better than an after-the-fact defence;
•expose the employee to as much bright light as you can, either from a window or a commercially available light box. If it is a sunny day encourage the employee to go out. If it is gray and overcast, use as much light indoors as possible;
•encourage the sufferer to enrol in a stress management program;
•plan active events — organize a ski trip, skating party or a curling bonspiel;
•promote overall good health and encourage employees to be physically active, before the blahs take over;
•encourage the employee to regulate his light intake. Suggest he/she use less light in the evenings to regulate the body’s circadian rhythm; and
•if the employee feels he/she is still sinking, encourage him/her to seek professional help. What the person learns from this season is something he/she can use in the falls and winters to come.
