Every year starting in mid- to late summer, you get that queasy, sinking feeling in the pit of your stomach, a gnawing malaise that grows stronger as the days get shorter. You may find yourself sighing more, feeling tired and listless, seeking solace in Reese’s Peanut Butter Cups or M&Ms. Your heart rate increases at the sights and sounds of external change-of-season cues: the appearance of the first back-to-school ads, the town pool closing its snack bar for the summer, outdoor activities ending at 6 pm instead of 7, BOGO sales on sunscreen. And then it comes: The first colored leaf dances ever so slowly in the breeze, lilting to and fro before landing softly on your shoe as if to taunt you. Sound familiar? If so, you may be one of the 4 to 6 percent of Americans suffering from Seasonal Affective Disorder (SAD). According to Harvard Health, roughly 500,000 people are diagnosed with SAD annually—and there are many more who aren’t diagnosed.
“It’s been around for a very long time,” says world-famous psychiatrist and author Norman E. Rosenthal, MD, who is credited with “discovering” and naming SAD in the early 1980s. “I just put the story together.” It was Rosenthal’s landmark bestseller, Winter Blues, first published in 1993, that drew initial attention to the cluster of symptoms he identified as Seasonal Affective Disorder. And it was his own winter depression that inspired him to conduct research on mood disorders and the seasons at the National Institutes of Health (NIH). “I realized that, when I first came to the States from South Africa, I started to be slower, less productive, and less creative,” Rosenthal recalls. “I had never lived far from the equator, so I was completely unfamiliar with the short, dark days of winter. When summer came, everything was easier and better.”
But SAD is more than just feeling “down” because it’s cold and dark. (In fact, it’s the darkness more than the cold that fosters SAD.) “The decrease in sunlight causes biological changes in the brain that are responsible for the depressive symptoms,” explains Howie Schrage, MD, a psychiatrist in private practice in Mount Kisco. “The brain’s biological internal clock is affected by the decrease in sunlight,” causing it to overproduce the hormone melatonin and to underproduce the neurotransmitter serotonin, which, says Schrage, can cause depressive symptoms. “There is also a hereditary component to SAD.”
Westchester is a perfect breeding ground for winter SAD, as the farther north people live from the equator, the more susceptible they are to the disorder. Those who develop SAD can have symptoms typical of clinical depression—including daily depressed mood, loss of interest in usual activities, feelings of hopelessness—but, says Schrage, there are symptoms that “are more unique to SAD, including irritability, increased appetite with weight gain most likely caused by carbohydrate cravings, fatigue, oversleeping, and increased sensitivity to rejection.”
So what can you do other than to wait with bated breath for June? “Light therapy is an effective treatment,” says Schrage. “In my practice, I’ve seen its users benefit greatly. Exposure to light from a light box on a daily basis can diminish or eliminate symptoms within several days to two weeks or longer.” Light therapy, he says, should be done under the supervision of a psychiatrist, and those who don’t respond to light therapy “may benefit from treatment with antidepressant such as fluoxetine [Prozac] or bupropion [Wellbutrin or Aplenzin].” Of course, psychotherapy can be helpful, and both doctors agree that exercise is important. Still, “whether by going outdoors on a sunny winter day or using lamps and light boxes indoors,” says Rosenthal, “people need to get more light.”