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She's 19 and lives in sunny California, and for as long as she can remember, her moods have followed the seasons like clockwork. She falls into depression when the days shorten in October, still feels glum during her birthday in January and then snaps out of her funk in March.
According to her psychiatrist, Marc Graff, M.D., at Kaiser Permanente, a nonprofit health maintenance organization in California, this woman has seasonal affective disorder (SAD), a type of depression linked to decreased exposure to daylight.
SAD can occur in the summer but typically happens in late autumn and winter because of the reduced amount of sunlight. Winter depression may affect 4 percent to 6 percent of Americans, and another 10 percent to 20 percent may have mild symptoms of SAD, according to the American Academy of Family Physicians (AAFP).
"It is certainly under diagnosed," Graff says. "People should get help. It's quite treatable."
Causes and risk factors
Your heartbeat, blood pressure, breathing, hormones, enzymes and other bodily functions rise and fall in a 24-hour pattern called your circadian rhythm. For some people, decreased exposure to sunlight throws off their circadian rhythm and can lead to symptoms associated with SAD.
It's unclear why some people are susceptible to seasonal depression, says Graff, though genetic researchers have identified two of the genes that are believed to control the body's biological clock. Researchers also believe that reduced daylight may boost the production of melatonin, a sleep-related hormone released by the pineal gland in the brain that may cause symptoms of depression.
Many people report feeling sluggish during dark days of winter. So how do you know if you have SAD? The difference is, people suffering from SAD usually feel they are unable to function normally. Some symptoms, such as anxiety, irritability and a general loss of interest or motivation, are common in SAD and many types of depression. If you suspect you have SAD, health experts say you should watch for one or more of these unique symptoms:
- Mood changes during late autumn and winter for at least two consecutive years, followed by the absence of symptoms during the spring and summer.
- Weight gain and cravings for carbohydrates, particularly sweets and starchy foods.
- Oversleeping or difficulty awakening in the morning.
SAD is more frequently diagnosed in northern states and countries; it affects seven times more people in Washington state than Florida, the AAFP says. Sixty percent to 90 percent of the people treated for SAD are women, Graff says. The average age for a person diagnosed with seasonal affective disorder is 23, and the chance of developing SAD decreases with age.
One of the biggest problems with SAD and other types of depression is that people do not recognize it as an illness. About 19 million Americans suffer from major depression each year, according to the National Institute of Mental Health. Yet research indicates that one-third of people suffering from a major depressive episode do not seek treatment.
"People don't appreciate at times that they may really have a condition. Sometimes, relatively minor changes can make a big difference in their life,'' says Michael Blumenfield, M.D., professor of psychiatry at New York Medical College and chairman of Joint Commission on Public Affairs for the American Psychiatric Association.
Light treatment
If you're diagnosed with SAD, your health care provider will likely recommend using a special device called a light box that emits "full spectrum" light - the form of light that most closely resembles sunlight, Graff says. "Regular lights are not bright enough," he says.
Light boxes cost about $200 to $300. You'll need a 30-minute session every morning to ease your symptoms, Graff says.
"Light therapy alone will probably do it for most people,'' Graff says. If not, your doctor will likely prescribe antidepressants.
If you believe you're prone to seasonal depression, Blumenfield says there are other things you can do to take advantage of winter sunlight:
- Spend more time outdoors during the day.
- Put your desk next to a window at home.
- Take advantage of the window in your office (if you have one).
- Buy a light box, and use it while doing a routine activity, such as reading. "You don't want to stare at the light because you can get a headache and eye strain,'' Blumenfield says.
 Children, teens and adults being treated with antidepressants, particularly anyone being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the Food and Drug Administration (FDA). The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor.
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External Sources
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Seasonal Affective Disorder, American Family Physician, American Academy of Family Physicians, March 1, 2000
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National Mental Health Association
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The Food and Drug Administration
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This article was reviewed and updated June 2007.
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