May 27, 2020

Winter Blues or Seasonal Affective Disorder?

Call it what you like —  a drink or two will fix it, right?

By Bill Manville
There’s an apt saying: “One martini is perfect. Two are too much. Three aren’t enough.” I was getting over a marriage gone bust. I can remember the day, the quality of the light. My windows rimmed with dirty snow, a gray dismal February afternoon mirroring the gray dismal dirty snow feeling within. 
I was 10 or 12 years sober by then. Long enough to have gained a measure of self-control, right? I would cheer myself up with that one perfect martini, I assured myself, pouring a precise two ounces of gin into my glass, not one drop more.
Adding vermouth, I stirred, the gin so cold it smoked off the ice. “Here’s to an end to self-pity,” I said, lifting the drink to my lips. That’s when some 12-step voice inside said, “Call Polly first.”  
An old Alcoholics Anonymous friend — perhaps more than that — she answered my unspoken message. “Put the glass down,” she said. “Get out of your gloomy New York winter, and come visit me in Key West.”  
I can’t explain it, but let me cite a fact: The moment I got off the plane — the quality of the sunshine, the brightness of the Florida light — the self-pity dropped from me. The urge to have a drink, too. 
I’ve now been sober more than 30 years 

What Is Seasonal Affective Disorder?


As a long-ago resident in the psychiatry program at the New York State Psychiatric Institute, the now-famed Dr. Norman Rosenthal noticed that he was more energetic and productive during the long, bright days of summer than the shorter, darker days of winter. 
In 1980, his team at the National Institute of Mental Health (NIMH) admitted a patient who had observed depressed seasonal changes within himself. Rosenthal treated the patient with bright lights, which helped to successfully manage the depression. The results were published in 1984, and Rosenthal has been credited ever since with pioneering light box therapy.
Although we don't know the exact causes of seasonal affective disorder (SAD), some scientists think that certain hormones made deep in the brain trigger attitude-related changes during the dark months of the year. Experts believe that SAD may be related to these hormonal changes.
One theory is that less sunlight during fall and winter leads to the brain making less serotonin, a chemical linked to brain pathways that regulate mood. When those nerve cell pathways don't function normally, the result can be depression, fatigue and weight gain.

Ways to Ease Seasonal Depression Symptoms


Alfred Lewy, MD, a seasonal affective disorder researcher at the Oregon Health & Science University, says it's not only a matter of getting light but also getting it at the right time.
“The most important time to get light is in the morning,” he says.
He thinks seasonal affective disorder is due to a “phase-shift” of the circadian rhythm. The wall clock may tell you it's time to get up and at 'em, but your body's internal clock says you should be resting. Bright light in the morning resets your circadian clock.
Sound like hocus pocus to you? The world-renowned Mayo Clinic says light box therapy “causes a chemical change in the brain that lifts your mood and eases other symptoms of SAD. Most people use light boxes for a minimum of 30 minutes each morning.”  
You can buy a light box on the internet or over the counter; your doctor may recommend a specific brand. Most health insurance plans do not cover the cost. Light boxes are designed to be safe and effective, but they aren't approved or regulated by the Food and Drug Administration (FDA), so it's important to understand your options. 
Ana Aluisy has a master's degree in rehabilitation and mental health counseling. Because she does not use light box therapy with her SAD clients, I turned to her for alternate ideas of treatment. 
“Depressive disorder with seasonal pattern, formerly known as seasonal affective disorder (SAD), is a type of depression characterized for the correlation between symptoms of depression and a particular time of the year,” she says. “In order to establish a diagnosis, an individual has to report symptoms for at least two years with the temporary relationship. Psychological stressors, such as seasonal unemployment and school schedule, need to be ruled out. Romantic and/or marital troubles may enter, too. Some people like you get off a plane in Florida and have a very strong, immediate reaction to light. However, one dramatic anecdote is not scientific evidence. More research needs to be done in this area. 
“Effective treatments other than light boxes may include medications and psychotherapy,” Aluisy says. “In my opinion, psychotherapy is imperative in an effort to learn to identify, prepare and cope with symptoms of depression because depression is a serious illness that can lead to suicidal ideations.”
I asked her about recovering people reading us in Renew. “What are the symptoms that tell them they may be suffering from SAD?”
The symptoms she named include: 
  • Loss of energy
  • Excessive sleepiness
  • Overeating
  • Feelings of helplessness and hopelessness
  • Loss of interest in daily activities
  • Self-loathing

We all have these feelings occasionally, but if they intensify for you every winter, you may well benefit from SAD treatment. 

Your doctor may recommend starting with light box therapy or recommend antidepressants before your symptoms typically begin each year.
“Keep in mind,” Aluisy says, “that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.”
All fine, yes? But as a 12-stepper myself for all these years, let me end with this: Maybe you can’t control the quality of light where you live, but you can control the hand that picks up that drink.

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