Winter Depression: Family Physicians Remind Minnesotans SAD is Treatable

Wednesday, November 8, 2001

We’ve set the clocks back; meteorologists are talking snow, and thousands of people will now be driving to and from work in the dark. Some Minnesotans adjust to winter with ease, but for others, it’s the start of a long, SAD season. That’s because they’re among an estimated 10 million Americans who suffer from a serious form of depression called Seasonal Affective Disorder (SAD).

“SAD usually sets in during the late fall or early winter when the days get shorter and there’s less sunlight. It typically goes away by the spring,” said Amy Bonifas, M.D., a Twin Cities family doctor and member of the Minnesota Academy of Family Physicians.

Researchers believe winter depression is likely caused by decreased exposure to the sun. Insufficient light passing through the eyes inhibits the production of a brain chemical called serotonin, which affects a person’s mood. A lack of sunlight also increases the production of the chemical, melatonin, which contributes to depression. “Heredity, stress and underlying depression can also play a role,” Dr. Bonifas said.

Symptoms of SAD usually come back year after year. They include a craving for sweet or starchy food, weight gain, a heavy feeling in the arms or legs, a drop in energy level, fatigue, a tendency to oversleep, difficulty concentrating, irritability, anxiety, and social withdrawal. They may also include symptoms that are present in other kinds of depression, such as feelings of guilt, a loss of interest or pleasure in activities you used to enjoy, ongoing feelings of hopelessness or helplessness, or physical problems such as headaches and stomachaches.

Research indicates as many as 4 to 6 of every 100 people may have SAD. Another 10% to 20% experience a mild form of the disorder, sometimes referred to as the ‘winter blues’. It’s also noted that women with SAD outnumber men four to one. The disorder is more common the farther north you go. In Minnesota, for example, it’s estimated at least 8% of the population could be affected by SAD. In a southern state like Florida, the disorder affects less than 2% of its residents.

Since SAD is a common public health problem, the Minnesota Academy of Family Physicians seeks to remind people that, once detected, the disorder is treatable. “Light therapy is a main option for SAD sufferers,” Dr. Bonifas noted. “Timed exposure to a fluorescent light box works for many people.” During light therapy, a patient sits in front of a specially constructed box, which beams intense light at them. Generally, the therapy takes 30 minutes a day throughout the fall and winter.

Of course, light therapy doesn’t work for everyone. While light boxes can be purchased at medical supply stores or ordered on the internet, the MAFP stresses that Minnesotans should see their doctor before using a light box. Caution is required with light therapy for those with manic-depressive disorders, skin that is sensitive to light, or medical conditions that make their eyes vulnerable to light damage. It is important to talk with your doctor one-on-one. Light therapy isn’t always the best option. Your doctor may want to try anti-depressants, behavioral therapy or a combination of both.

Along with treatment, there are other things that can be done to help a person cope with winter depression. They include increasing the amount of light in a home by cutting back tree branches or removing dark window coverings, walking outside on sunny day, taking a mid-winter vacation to a warm climate and exercising regularly to relieve stress. Tanning beds are something the MAFP hopes patients will avoid.

“These beds are high in ultraviolet rays which can harm both your eyes and skin,” Dr. Bonifas concluded. “There’s no evidence tanning beds are useful in treating SAD.”

The Minnesota Academy of Family Physicians is a professional association of approximately 2,700 family physicians, family medicine residents and medical students organized to assist family physicians in providing quality medical care in Minnesota. The MAFP is the largest medical specialty organization in Minnesota and is a state chapter of the American Academy of Family Physicians, the largest medical specialty organization in the United States with more than 93,000 members.