October 24, 2014

Medina
Mostly clear
40°F

Dr. Rakesh Ranjan – Seasonal Affective Disorder

Dr. Ranjan

Dr. Ranjan

Audrey was fuming. A manager at a busy Cleveland accounting firm, she sat stonily silent at the head of the conference table. Her staff, accustomed to Audrey’s angry outbursts, watched her warily.
“Business is down and I want answers!” Audrey demanded. She could see her staff visibly wince at the harsh pitch of her voice.   Her boss, sitting at the other end of the table, raised an eyebrow. Tone it down, his look told her.
Back in her office, Audrey remembered something her mother used to say: “Audrey, sweetie, you’ll catch more bees with honey than vinegar.”
Even as a kid, Audrey had felt a certain sadness during the winter months. She recalled acting out with tears and defiance.
“The Winter Blues,” her mother would say, “it will pass.”
But now that Audrey was an adult, the black mood was persistent. The darker the Cleveland sky, the darker her mood became.
With her parents gone, Audrey’s only support came from her friends.  But that particular winter she felt too sad to reach out to them.  And she was embarrassed by the weight she had gained.  It seemed all she craved was pasta or chocolate. Audrey’s isolation grew.
One day her boss called her into his office. “Audrey, I’m worried about your moodiness and lack of focus,” he said, “It’s affecting your work performance and, frankly, it’s affecting the entire staff.”
Audrey knew she had to change, but she didn’t know where to begin.
That evening, Audrey burrowed down in bed with a box of chocolates and turned on the TV.  And that’s when she saw a commercial by an area psychiatrist that changed her life. He was conducting a study on Seasonal Affective Disorder. Audrey realized she had most of the symptoms described in the commercial.  But, more important to Audrey, it was a treatable condition!
She joined the study and, to her delight, began to feel better. To this day, Audrey continues to see the psychiatrist to ensure that Seasonal Affective Disorder (SAD) never brings her down again.

What is SAD?
SAD is a type of recurrent depression that begins and ends at the same time year after year.
Types of SAD
Contrary to popular belief, SAD does not occur only during winter months.  SAD comes in two forms: Winter Depression and Summer Depression.
Winter Depression
This is the more common form of SAD.  It usually appears during late fall or early winter and resolves during mid to late spring or summer.
The symptoms of winter depression typically consist of the following:
•    Significant, daily feelings of sadness.
•    Significant anxiety.
•    Severe feelings of hopelessness.
•    Significant social withdrawal.
•    Excessive sleep.
•    Increased appetite (including carbohydrate craving), at times resulting in weight gain during winter months.
•    Poor energy or feelings of lethargy.
•    Poor interest and diminished enjoyment in pleasurable activities.
•    Poor concentration.
•    Significantly impaired daily functioning at home and/or work.
Winter Depression vs. ‘Winter Blues’
Many of us may experience ‘blue’ feelings in winter months: these are typically transient, mild in nature and do not significantly affect our daily functioning .  However, when these ‘blue’ feelings become a daily and routine occurrence during winter months, occur every winter and significantly affect your daily functioning, you most likely have SAD.
Summer Depression
This is a less common form of SAD whereby symptoms of depression appear at the beginning of spring or summer.
The symptoms of Summer Depression are somewhat different from those of Winter Depression.  These typically consist of the following:
•    Severe daily feelings of sadness.
•    Severe feelings of anxiety.
•    Significant irritability.
•    Significant agitation or restlessness .
•    Decreased appetite, sometimes accompanied by weight loss.
•    Increased sex drive.
•    Significant impairment of functioning.
Reverse Seasonal Affective Disorder
Some people who have winter depression experience symptoms of mania or hypomania  (a less severe form of  mania) during spring and/or summer months.  These symptoms include feelings of elation, agitation, increased social activity, increased energy, impulsive behavior, racing thoughts and rapid speech, etc.  Reverse SAD is considered to be a variation of Bipolar Disorder.

What causes SAD?
As with other neurobiological disorders, the exact cause of SAD is unknown.  However, the following facts are relevant:
•    Circadian Rhythm:  Sunlight serves as an important cue to our biological clock in telling us when to sleep or be awake.  The reduced level of sunlight in winter and fall causes  disruption of the internal clock, which, it is believed, may cause depression.
•    Melatonin: Melatonin is a chemical found in our brain that plays a role in regulating sleep and the mood.  Seasonal climate changed affect melatonin levels and thus may cause depression.
•    Serotonin: Decreased amount of sunlight during winter months can decrease brain levels of Serotonin, a neurotransmitter, which plays a role in regulation of mood, appetite, sleep, and sex drive.
•    Equator:  The farther one lives from the equator,  the higher the risk one has for developing SAD.  This again, may be related to decreased sunlight during winter.
•    Genetics:  There is some evidence that SAD may have a genetic basis.
•    Female: Females are more likely to suffer from SAD.

Treatment of SAD
•    Light Therapy: Regular exposure to certain wavelengths of light during winter months has been found to be helpful.  Please consult your doctor before ordering a light therapy box.
•    Medications:  These are typically most effective.  Wellbutrin XL (an extended – release form of antidepressant Bupropion) is quite effective .  SSRIs (Selective Serotonin Reuptake Inhibitors e.g. Prozac, Zoloft, etc.) and Venlafaxine (Effexor) may also be helpful.
Mood stabilizers are the best options to treat Reverse SAD.
•    Psychotherapy: As with other forms of depression, it is an effective treatment.
•    Relaxation Techniques: Yoga and meditation may be helpful adjuncts.
Please note that you should consult your family doctor or a mental healthcare specialist at the earliest signs of any kind of impairments and/or suicidal thoughts.

Next Week: The Truth About Eating Disorders

The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peerreviewed journal articles and book chapters on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for the NAMI of Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at askthedoctor@charakresearch. com. Each Wednesday, Dr. Ranjan will address some of these questions in this column. All contact info will be kept confidential.