We in Northeast Ohio are all too familiar with the dreariness of winter.
With winter comes cloudy, snowy, icy and below-zero days.
That lack of sunshine can also affect our moods — both on an occasional basis as well as more seriously in the form of a type of clinical depression called seasonal affective disorder, or SAD.
So for this month’s Healthy Action column, I sought the expertise of Kristen Knepp, a psychologist with Summa Health.
Q: What is SAD?
A: It’s not a diagnosis on its own. It’s a subtype of a major depressive disorder. Typically, there is a very clear pattern of during most often the winter — it can be during the summer, but most often the winter or fall months — there are symptoms of depression, such as low mood, sadness, fatigue or loss of energy. Those will persist throughout the fall and winter months and completely remit by spring and summer.
In order for an actual diagnosis of SAD, there has to be a clear seasonal pattern with full remittance (or going away) in the offseason for a period of at least two years. The person has to have more seasonal episodes than nonseasonal episodes over a lifetime in order for it to be SAD as opposed to another type of depression.
Q: Is there such a thing as the winter blues and what’s the difference between that and clinical depression?
A: They are very similar concepts. With both of them, you’ll have symptoms of loss of energy, low mood and sadness. Maybe the person is crying more frequently than they normally do. Or they might have feelings of worthlessness or guilt.
With seasonal affective disorder, the question is how much is it affecting life and the person’s quality of life? Are they missing out on obligations? Are they socially isolating themselves? Are they almost hibernating by staying in and declining invitations?
Are they having trouble carrying out their normal responsibilities, whether at work or school or in family or relationships?
Q: I notice I seem peppier when I’m driving to work and the sun is out and I’ve got my sunglasses on instead of when it's dreary out. Is it normal to feel “down” during the winter or for the sun to change our moods?
A: Winter blues are very typical and very common, especially for people living in this part of the country.
Again, we need to look at how much it is affecting someone’s life and how long its been going on. If it's a clear pattern that has persisted for the last couple of years and as soon as we get into springtime, your mood really changes, then someone in that situation might consider being evaluated by a medical professional. Or if your winter blues’ feelings of feeling unproductive, changes in appetite or craving more carbohydrates than normal have persisted for several weeks, seek professional assistance.
Anecdotally, I think the sun affects people’s moods a great deal. There are studies about the prevalence of SAD in different parts of the United States. In Alaska or New England, rates can be as high as 10 percent, but in Florida it's 1 percent.
Q: What do you think the prevalence is in Ohio?
A: I’m not sure, but we believe that this disorder is under-diagnosed because it’s under-reported. People shrug it off and dismiss it saying “everybody goes through this, it’s the winter blues.” Sometimes, people will not necessarily tell their doctor about these symptoms.
Also, women are four times more likely than men to be diagnosed, though women may be more likely to go to the doctor.
We also don’t see a lot of SAD in children or youth or older adults, though it can happen. Typically, SAD is diagnosed in young adulthood from 18 to 30, but could last through adulthood.
Q: Where should I go seek help?
A: People typically go to their primary care doctor first. Oftentimes, they will refer to a psychologist. A patient may also work with both a psychologist and a psychiatrist or nurse practitioner, who can prescribe medications.
Q: Can you tell me about SAD light therapy?
A: Light therapy involves sitting in front of a light box that emits 10,000 lux, which is about 20 times greater than normal indoor lighting, for 20 to 30 minutes a day. It is preferable that it is in the morning and as soon as the person wakes up. Light therapy helps with the regulation of serotonin and in the morning, those levels tend to be naturally low.
There is some evidence that shows doing light therapy at night can impact people’s sleep, so it is not recommended at night.
It is recommended that people consult with their doctor before pursuing light therapy, even though the lamps can be purchased at retail stores and online at such retailers as Amazon.
There are some psychological disorders, such as bipolar disorder, where light therapy would not be recommended.
People really need to give it at least four weeks and see if they notice a difference and they need to be consistent about it. Work with a doctor to establish an appropriate amount of therapy. There is a risk of symptoms coming back if light therapy is discontinued too soon.
Betty Lin-Fisher can be reached at 330-996-3724 or email@example.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/topics/linfisher