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When wintertime sadness is serious

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January 6th, 2017
Person with seasonal affective disorder.
Person with seasonal affective disorder.

Seasonal affective disorder (SAD) is a short-term condition characterized by symptoms of depression. Although it can happen any time of year, most people are affected in fall and winter. 

Less exposure to outdoor light is thought to be a main trigger for winter SAD. It disrupts your biological clock, which may lead to fewer natural brain chemicals (neurotransmitters) that regulate your mood. 

What about summertime SAD?

Because less daylight isn’t likely the cause in summertime, researchers have investigated other causes. People prone to the condition may have a preexisting imbalance in neurotransmitters responsible for mood regulation or overproduce melatonin, which regulates sleep patterns. Studies also show that people with SAD may produce less vitamin D.

“People 71 years of age and older are at increased risk for low vitamin D levels because of changes that come with age,” says Matt Narrett, M.D., chief medical officer for Erickson Living communities. 

“Health problems can contribute to signs of depression,” says Roberta Feldhausen, R.N., P.M.H.-C.N.S., B.C., director of mental health services at Riderwood, an Erickson Living community in Silver Spring, Md. “Thyroid disease or a lack of sufficient vitamin B12 have been associated with low mood.”

Sad events occurring in winter can exacerbate your depressed mood. “Studies show that more older adults die in the winter months, especially holiday time, than any other season of the year,” Feldhausen says. “Grief can compound your symptoms.” 

When do you need treatment?

“The symptoms of SAD are practically indistinguishable from clinical depression,” Feldhausen says. “The only difference is how long symptoms last—if it’s more than two weeks, you may be clinically depressed.”

Typical symptoms of SAD, according to the National Alliance on Mental Illness, are oversleeping, daytime fatigue, weight gain, and a craving for carbohydrates. With summertime SAD, people may experience weight loss, insomnia, and anxiety. 

“Research also shows that some seniors do not experience typical signs of depression,” Narrett says. “Instead, they may have cloudy thinking, feel uncomfortable in social situations, or simply attribute their problems to another physical cause.”

What’s the most effective treatment?

Light therapy, in which you sit close to a specialized box that emits bright light similar to outdoor light, is a standard treatment. Exposure to this light seems to affect mood-related neurotransmitters. Research shows that it is as effective as antidepressants for many people who have less severe SAD.

For people with SAD, which is having a significant effect on their daily functioning, a combination of therapies has been shown to be the best strategy. “You may need light therapy, medication, and counseling,” Feldhausen says.

Alternative therapies, such as acupuncture, massage therapy, or yoga, may help some people. Dietary supplements, on the other hand, need to be cleared by your doctor. “Supplements and herbal preparations are not FDA-approved as safe or effective,” Narrett says.

A new novel treatment

Transcranial magnetic stimulation (TMS), or repetitive transcranial magnetic stimulation (rTMS), has been shown to be effective for symptoms of depression. The procedure begins with a treatment coil that’s applied to the left front portion of your head. “A magnetic field is focused on the left dorsolateral prefrontal cortex, the portion of your brain that is less active due to depression,” says Kimberly Cress, M.D., a nationally recognized psychiatrist who specializes in TMS for people with depression. “This magnetic field does not directly affect the whole brain, only traveling about two to three centimeters directly beneath the treatment coil. As this magnetic field moves into the brain, it produces very small electrical currents. Ultimately, these currents activate neurons within the brain, which are thought to release depression-alleviating neurotransmitters like serotonin, norepinephrine, and dopamine.”

It may sound a little intimidating, but according to Cress, TMS produces the same type and strength of magnetic field as a magnetic resonance imaging (MRI) machine. “Because it is a nonsystemic treatment, meaning it does not circulate in the blood stream,” she explains, “the most common side effect is mild scalp discomfort.”

A typical TMS session lasts 30 to 40 minutes, for a duration of four to six weeks, depending on your condition. If you want to try TMS, talk to your doctor. “Although it is FDA-cleared, safe, and well-tolerated with very few limitations, not all patients are appropriate candidates,” Cress says. “A full medical background screening should be completed prior to starting TMS therapy.”

According to the Mayo Foundation for Medical Education and Research, people with implants, such as pacemakers, defibrillators, cochlear implants, and stents, should not have TMS.

“Remember, if you’re feeling down or hopeless for more than a few days in a row, talk to your regular doctor or a health professional you trust,” Narrett suggests. “You can feel better and enjoy life again.”


DIY treatment strategies

Regardless of the treatment you receive, there are ways to maximize your treatment’s effectiveness or prevent SAD altogether.

Brighten up your environment. Open the curtains, trim foliage that may be blocking light, or add skylights to your home.

Get outside in any weather. Experts say that exposing yourself to outdoor light is most effective if you do it within two hours of waking up in the morning.

Exercise regularly. Physical activity is proven to lighten your mood and relieve anxiety, and being in better physical condition improves your overall health.

Connect with family and friends. Socializing has been shown to improve mood.

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