When it’s Grey, watch out for those Blues

When it’s Grey, watch out for the Blues

Most stories about Seasonal Affective Disorder (Winter Blues) arrive in the media around early November. Mostly because the majority the media in the world are based in the northern hemisphere. It is important to remember,  just because it is getting toasty in North America, that somewhere in the world it is beginning to get chilly. 

Every year I write and article on seasonal depression an share some of my research from my time at 65 degrees North latitude. This year I decided that it might be important to recognize my dear friends in the southern hemisphere who are about to enter their winter period beginning June 21. So all you Down Under this story is for you. With winter around the corner many people suffer from the blues, a mild depression brought on by a decrease in exposure to sunlight as autumn deepens. This story is intended to provide useful information concerning the symptoms of SAD and the effective methods on how to treat the winter blues.

Those suffering from the winter blues fall into a depressed mood each year in the fall and continue to feel depressed throughout the winter and into the early spring, when these feelings disappear. The winter blues and its more severe counterpart, Seasonal Affective Disorder (SAD), affects about four times as many women as men. Nearly 25% of all college students across the United States suffer from the winter blues and this percentage increases at higher latitudes or more cloudy areas, such as the Ithaca region.

The winter blues are primarily caused by unstable melatonin levels, a hormone produced during sleep, and serotonin, a neurotransmitter responsible for mood, hunger, and sleep. As the days become shorter and the hours of sunlight decrease, sufferers of the winter blues experience changes in their mood, energy level, and ability to concentrate. Although the winter blues are not as severe as long-term depression,they can change the way a person thinks, reacts, and deals with everyday challenges.

Augusta Chronicle on Blues Season

Research sheds revealing light on a depressing disorder many people endure

He thought it might just be the stress of moving thousands of miles away from home to a new Army post. But as the days grew shorter, Albert Milliron found himself slipping into a sluggish depression that worsened as the hours of daylight dwindled.

“My production level went from someone who is very productive to someone who was rarely productive,” said Mr. Milliron, an Augusta researcher and substance-abuse counselor.

Originally, he was treated for depression, but eventually he realized that the short days and lack of daylight were part of his funk.

Commonly called “the winter blues,” seasonal affective disorder (SAD) is a very real problem for about 10 million people a year. The difficulty for those who treat it, including Jeffrey L. Rausch of Medical College of Georgia, is determining who is suffering from the disorder, who is simply depressed, and who may be coming down with the “holiday blues” common during this season.

People with SAD have lost the natural rhythm that signals the body to fall asleep and awake at the proper times, Dr. Rausch said. The body’s light-sensing pineal gland responds to lessening light by secreting the hormone melatonin, which helps bring the body to rest. Daylight signals the gland to shut off melatonin and allow the body to come awake.

But maintaining that cycle becomes more difficult for some people as the days grow shorter and light grows more scarce. Dr. Rausch likens it to the way the shorter days create hormonal changes in hibernating animals, causing them to sleep more, eat less, and slowing their metabolisms.

“We know that people don’t hibernate, but what we think is that there are mirrors,” or similar responses in humans, he said. Those with the disorder may experience similar sleep and eating changes. They also may have trouble concentrating, may become depressed and may even consider suicide.

Mental Health America: Seasonal Affective Disorder (SAD)

Some people suffer from symptoms of depression during the winter months, with symptoms subsiding during the spring and summer months. These symptoms may be a sign of seasonal affective disorder (SAD). SAD is a mood disorder associated with depression and related to seasonal variations of light. SAD affects half a million people every winter between September and April, peaking in December, January, and February. The “Winter Blues,” a milder form of SAD, may affect even more people.

Prevalence

Three out of four SAD sufferers are women.

The main age of onset of SAD is between 18 and 30 years of age.

SAD occurs in both the northern and southern hemispheres, but is extremely rare in those living within 30 degrees latitude of the equator.

The severity of SAD depends both on a person’s vulnerability to the disorder and his or her geographical location.

Symptoms

A diagnosis of SAD can be made after three consecutive winters of the following symptoms if they are also followed by complete remission of symptoms in the spring and summer months:

Depression: misery, guilt, loss of self-esteem, hopelessness, despair, and apathy

Anxiety: tension and inability to tolerate stress

Mood changes: extremes of mood and, in some, periods of mania in spring and summer

Sleep problems: desire to oversleep and difficulty staying awake or, sometimes, disturbed sleep and early morning waking

Lethargy: feeling of fatigue and inability to carry out normal routine

Overeating: craving for starchy and sweet foods resulting in weight gain

Social problems: irritability and desire to avoid social contact

Sexual problems: loss of libido and decreased interest in physical contact

Causes

As sunlight has affected the seasonal activities of animals (i.e., reproductive cycles and hibernation), SAD may be an effect of this seasonal light variation in humans. As seasons change, there is a shift in our “biological internal clocks” or circadian rhythm, due partly to these changes in sunlight patterns. This can cause our biological clocks to be out of “step” with our daily schedules.

Melatonin, a sleep-related hormone secreted by the pineal gland in the brain, has been linked to SAD. This hormone, which may cause symptoms of depression, is produced at increased levels in the dark. Therefore, when the days are shorter and darker the production of this hormone increases.

Treatments for Seasonal Affective Disorder

Phototherapy or bright light therapy has been shown to suppress the brain’s secretion of melatonin. Although, there have been no research findings to definitely link this therapy with an antidepressant effect, light therapy has been shown to be effective in up to 85 percent of diagnosed cases. Patients remain in light up to ten times the intensity of normal domestic lighting up to four hours a day, but may carry on normal activities such as eating or reading while undergoing treatment. The device most often used today is a bank of white fluorescent lights on a metal reflector and shield with a plastic screen.

For mild symptoms, spending time outdoors during the day or arranging homes and workplaces to receive more sunlight may be helpful. One study found that an hour’s walk in winter sunlight was as effective as two and a half hours under bright artificial light.

If phototherapy does not work, an antidepressant drug may prove effective in reducing or eliminating SAD symptoms, but there may be unwanted side effects to consider. Discuss your symptoms thoroughly with your family doctor and/or mental health professional.

Other Resources

Society for Light Treatment and Biological Rhythm

P.O. Box 591687

174 Cook Street

San Francisco, CA 94159-1687

www.websciences.org/sltbr

DISCLAIMER: Mental Health America does not endorse any specific mental health treatments or services. In addition, it is not the intention of Mental Health America to provide specific medical advice but rather to provide readers with information to help them better understand their health and, when necessary, find the treatment that works best for them.

Sources: The Harvard Mental Health Letter

The SAD Association Homepage. Accessed February  http://www.sada.org.uk/symptoms.htm.

Winter Blues Light Therapy with Daylight

If your main problem is the winter blues, it is reasonable to try self-treatment with light therapy if you follow recommendations like those from the Center for Environmental Therapeutics www.cet.org or a book like Norman’s Rosenthal’s Winter Blues (which you can order through CET).

Bright Light therapy for the winter blues is the same as light therapy for Seasonal Affective Disorder (SAD). Just because your symptoms are relatively mild does not mean that you are going to need a lower dose of light. Both SAD and winter blues sufferers often respond to the same treatment regimen: 10,000 lux light box therapy for 30 minutes upon awakening. As you get the hang of it, you will sense whether you need to increase exposure duration (say, to 45 minutes) or decrease it (say, to 20 minutes) to get an optimum response. Many people decide to increase the duration above 30 minutes during January and February, then reduce it to 30 minutes in March and April.

Arctic Medical Research 1994

Arctic Medical Research 1994; 53: 25-34

Diurnal and Seasonal Rhythms of Melatonin, Cortisol and Testosterone In Interior Alaska

Matthew E. Levine (1) Albert N Milliron (1) and Lawrence K. Duffy (2)

(1) Community Mental Health Services, Fort. Wainwright, Alaska, (2) Institute of Arctic Biology, and Department of Chemistry, University of Alaska Fairbanks, Fairbanks, Alaska

Abstract: The diurnal variations in the secretory patterns of melatonin, cortisol and testosterone were studied in a Fairbanks, Alaska population who were unadapted to the extreme light variations of the North. Statistically significant variations in hormonal levels were found in both diurnal and seasonal rhythms. Prominent findings included unusually high levels of cortisol at 0200 and 0800 in the fall and elevated daytime levels (1030) of melatonin in the winter. These results indicate a delayed phase secretory pattern when compared to the normal pattern at lower latitudes.

These findings imply possible underlying physiological causes for the high incidence of behavior disorders such as depression and alcoholism in Alaska and circumpolar environments in general.

Studies of the hormone levels in man under extreme environmental conditions are important because of their underlying contribution to behavior and physiological health (1).

Cortisol secretion has been shown to vary with season, especially in high latitudes (2).

Peak levels normally occur in the morning, suggesting that the circadian rhythms of cortisol secretion may be influenced by lightdark exposure (2,3), Evidence suggests that Iight-dark exposure may be the synchronizer of the pituitary-adrenal cycle in man, and that variation of the light-dark cycle alters plasma cortisol rhythms (4), It has been postulated that melatonin and cortisol secretion may be linked (5). Melatonin secretion normally occurs at night, with peak levels at about 0200, and is sensitive to light impulses received through the retina, with inhibition of secretion normally initiated by the reception, on morning arising, of light impulses through the retina (6,7).

The- apparent inverse relationship of diurnal peaks of melatonin and cortisol secretion raises the possibility that melatonin may mediate cortisol secretory patterns by stimulatingincreased cortisol production and secretion, most likely through a central mechanism, involving corticotropin releasing factor (CRF). Alternatively, high nocturnal melatonin levels may be inhibitory to the hypothalamic-pituitary-adrenal axis, with falling morning levels of melatonin resultiug in a release of inhibition of CRF secretion. Similarly, Kauppila et al.(8) , have proposed a relationship between melatonin and anteriorpituitary-ovarian hormones. Melatonin is the major known secretory product of the human, and other mammalian pineal glands. Its nmction is not yet fully understood, but it is known to have significant effects on the reproductive system, thyroid function, and adaptation to I Changes (3,8,9). There is also evdence· suggesting effects on sleep, dream and arousal pattems(10).

Melatonin has been shown to have significant physiological effects, and secretory patterns have been shown to be altered in a variety of psychiatric conditions, such as depression (13,14,15,16), bipolar disorder (16,17,18), schizophrenia (18), functional hypothalamic amenorrhea (19), eating disorders (14), migraine (20), seasonal affective disorders (21), and suicide (22). Melatonin in the morning hours (0800) has been studied during the dark winter season in Stockholm, Sweden Oatitude approximately 59°N) and have been found to remain elevated to greater than twice the levels found during the summer period, at the same time of day (9). Unfortunately, the study from Stockholm did not include midmorning (1000) or later morning levels, which may remain elevated. Melatonin and urinary melatonin have been measured in men and women in Oulu (65″N) and these studies have indicated a circannual variation (8,11,12).

At lower latitudes as well, seasonal and diurnal variation in the serum testosterone level have been reported (24). This circadian pattern in young males has been found to become blunted with aging (23). Multiple analyses of five Parisian males showed that peak serum testosterone levels occurred in October, and the levels were lower in April (24).

These reports conflict with an earlier study at 65″N which did not find any significant seasonal variation [11].

Additional SAD Resources:

• About the Winter Blues 
• Treatment of Seasonal Affective Disorder
• Additional online resources for SAD
• National Organization for Seasonal Affective Disorder

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