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  • Nov. 17, 2008

    It's a SAD time of year

    By Gabrielle J. Melin, M.D.

19 comments posted

Need more help?
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Less daylight during the fall and winter causes depression in some people.

Other factors contributing to seasonal affective disorder (SAD) may include genetics and age. We know that neurochemicals are involved in the regulation of our mood and functioning.

Melatonin is a hormone that our brains produce during the hours of darkness. It is involved with regulation of sleep, body temperature and release of hormones. As with any hormone, the amount produced is important.

People with SAD produce too much melatonin. This disrupts our internal body clock leading to depressive symptoms. If you have had episodes of depression that clearly have an onset in fall or winter followed by remission of symptoms in the spring or summer, you may have SAD.

Symptoms of winter-onset seasonal affective disorder include:

  • Depressed mood
  • Irritability
  • Hopelessness
  • Anxiety
  • Loss of energy
  • Social withdrawal
  • Oversleeping (feeling like you want to hibernate)
  • Loss of interest in activities you normally enjoy
  • Appetite changes, especially a craving for foods high in carbohydrates such as pastas, rice, bread and cereal
  • Weight gain
  • Difficulty concentrating and processing information

Medications or light therapy (phototherapy) can be used to treat SAD. The type of light used, distance from the light, and amount of time, are very specific. The light should be of adequate intensity, 10,000 lux (lux is a measurement of light intensity). At 10,000 lux, the amount of time required in front of the light is 30 minutes.

If the light is 5,000 lux, then the amount of time will be 60 minutes. You need to have your eyes open, so that the light can reach the retina in the back of your eye. You do not have to look directly at the light. You can read, knit, etc. The light purchased should have information on exactly how to use the light effectively. The distance you sit from the light will range from about 12-18 inches. The light will not emit damaging UV rays.

Speak with your health care provider if you think you may have SAD. Treatment is available. There are possible side effects, such as eye strain and headaches. Typically, light therapy is done in the morning, as it can cause insomnia if done too late in the day. If you struggle with bipolar, a hypomanic or manic episode can be triggered by light therapy, so should be used with extreme caution.

You can purchase a phototherapy light without a prescription, but speak with your provider first. Some insurance companies may cover some of the cost. Treat SAD, so you can enjoy this beautiful time of year!

19 comments posted

blog index

  • November 22, 2009 4:54 a.m.

    My question is about seasonal affective disorder (SAD), however as in my case, how offend does this happen to someone in the summer? Or is that a different disorder.

    - Robert

  • November 5, 2009 3:49 a.m.

    I have been living with SAD for 5 years. I use a light box, try and eat right, exercise, be mindful of my moods, talk when I need to and take a good increase in Vit D (up to 4000U) as well as other supplements. I am currently on Welbutrin 450mg and Zolft 100mg. I am wondering if any other medication has worked for someone. I work night, (I know not the best shift) and in the Winter its horrible to get to work at 11pm. So more or less wondering, any word on different medications

    - Shelley

  • October 27, 2009 1:55 p.m.

    I purchased a lightbox from Apollo Health several years ago-- Apollo has been bought out by Phillips so it should be easy to find their products on-line. The technology and style of their lights has improved. I use my lamp for 40-60 minutes in the early morning (upon waking) and 20 minutes in the late afternoon (5pm) for best results. Must be used consistently over a period of time to be effective. Start with a shorter period of time at the beginning of use and ease into longer sessions to avoid hypomania. Do not use within 3-4 hours of bedtime to avoid insomnia.

    - ABK

  • October 4, 2009 11:23 p.m.

    Ellen: how many IU of vitamin D 1000 or 2000 to aid in the symptons of sad

    - Mel

  • October 4, 2009 11:20 p.m.

    does vitamin d help with sad

    - mel

  • August 25, 2009 7:05 p.m.

    how can u tell someone has any form of depression? my mom has been "down" for quite some time if not years to be honest. she is always unhappy, feels left out and alone and when i asked what she feels in an attempt to help her talk her words were "i feel like i had an internal abortion (!!) and any kind of feelings were erased. I cannot feel anything and I am tired to anyway" I fear that telling her to visit a specialist will have a worse impact on her esteem. Besides I strongly want to avoid any involvement with any medical treatment.

    - x.

  • July 31, 2009 8:56 a.m.

    Light Boxes for Seasonal Affective Disorder: There are many complanies that make full spectrum lights- they come in different sizes. The main thing is to make sure the the intensity of the light is 10,000 lux. If the bulb gives off 5000 lux, you need to use it twice as long, so a box that gives off 10,000 lux will need to be used 20-30 minutes each morning. You can purchase light boxes on the internet. Call the company with questions before buying. Good luck!

    - Mayo Clinic. Com Staff

  • July 30, 2009 7:20 p.m.

    I tried to get a recommendation from my Dr. as to where to purchase a legitimate light therapy lamp for treating SADD. My Dr. contacted one or more persons in the psychiatric profession, but was unable to get a recommendation. Where does one purchase one of these light boxes?

    - Carol

  • January 7, 2009 1:37 p.m.

    I don't know is it a late feedback? Life Spring might be a kind of supplement what you mentioned.

    - Being

  • December 10, 2008 10:11 a.m.

    Does anyone know of a RX med or supplement that is supposed to REDUCE Melatonin that I could discuss with my Dr & Psych Therapist?????

    - Linda

  • December 10, 2008 10:00 a.m.

    I'm sufferer of yr-round, hard to treat depression, w/some bi-polar symptoms (more uni-polar than bi-polar ie rarely have multi-day energy bursts w/o sleep but do experience high agitation, outbursts, behavior control, trembling, mind/heart racing etc OR the opposite, sleeping for days in a row & no energy focus/interests etc. Diagnosed SAD 10 yrs & use light box in am AND PM (12 hrs apart)per Psych Therapist & MD - helps! Problem compounded by severe sleep apnea & thyroid disorder(take med). Get SLEEP TEST @ sleep lab if you snore! Treating sleep apnea can lessen SAD & depression & bi-polar! You must check this out w/your Dr. Covered by ins & so is apnea equip usually. Get in SUN whenever available, even if freezing, take a walk, bundle in blankets & coat and sit & read outside, anything outside! The more frequency out in SUN the better you'll feel. Florida vacations make a huge diff for me & if I go 4+ days, effect lasts appx 2+ weeks. If I feel total helpless/suicidal, I take a sunny long weekend (I keep a yr round fund for this) Even when SAD worsens it's not as severe. Everyone's SAD can be different! Mine begins @ Aug & relents in Mar! I even start getting excess energy in late Feb & I know I made it thru another yr! Because of sad/apnea combo, I take RX PROVIGIL as need to make me awake daytimes w/no naps. I was having slow reaction time, minor car accidents & it super helped. PROVIGIL developed for long distance tru

    - Linda B

  • November 19, 2008 8:57 p.m.

    I have been dealing with year around chronic depression and some very deep episodes of same during the winters for over 15 years. There just is not an easy fix. It takes strength and willpower to keep going on some days - especially in parts of the northeast that remain cloudy most of the winter. My experience shows that there is no one single "cure" for SADs or depression. I've found that proper diet including supplements like CoQ10, fish oil, my regular meds, light therapy, regular exercise, and if you're so inclined an active spiritual life all combine to help lessen the symptoms. Talking with close friends and relatives who have a sympathetic yet objective ear helps - so does counseling. Most days feel like normal - but there are those down days where embracing the condition and accepting it help to break the "bad karma" sometimes associated with denial. I appreciate all that the Mayo Clinic does to keep me informed. This was the one site that had the most comprehensive information about a rare cancer that I came down with several years ago. I've been a "customer" ever since. Hang in there everyone - there is hope.

    - Paul

  • November 19, 2008 9:57 a.m.

    Thank you for all of your comments! We will change the text to reflect the insightful comment below regarding people that have been diagnosed with bipolar disorder. Regarding the Vitamin D supplement comment and all supplements, check with your Health care provider as to the dose you should take. Excessive amounts of vitamins or supplements can cause significant health problems.

    - MC.Com Staff

  • November 19, 2008 5:51 a.m.

    Over the years I have noticed that more old people die in the winter, especially in January and October. Since Mama was widowed in October and she cannot go out much when the weather is bad, which it generally is up here where her children live, we are worried about her this winter. We are all depressed because of the election results, because of Daddy dying, and because we are beseiged by grabby hands demanding that we fork over to The Less Fortunate a Christmas replete with Nintendo Wii, Segway and iPhone (all brand new) under the tree. Since we in Toronto do not go outside in the winter anyway -- everything here is connected underground -- SAD does not affect the proletariat much.

    - Appleby Mennym

  • November 18, 2008 8:37 p.m.

    i went to my md thinking i might be bipolar. i considered i might have SAD. after trying TRYLEPTAL for a few days and having side effects of severe fatigue, i do believe i have SAD.

    - wilma

  • November 18, 2008 7:46 p.m.

    I believe the worst time of year is Spring.My son suicided April 1997, and my research has shown the most suicides occur in Spring, especially white, adult males..the highest suicides 1997. I disagree that winter is worst because in Spring, is new life, new hope, ..except to those depressed, who see no hope

    - Patricia Lewey

  • November 18, 2008 6:23 p.m.

    I appreciate the article. Light therapy is very helpful. One comment, though. In your blog, you stated, "If you are bipolar....". I think it is really important to not tag us as being bipolar, but rather someone living with Bipolar Disorder. Just a suggestion. Thanks.

    - No name given

  • November 18, 2008 3:55 p.m.

    Last year my therapist wrote a "Prescription" for the light therapy. It did help. The lights are small and easy to use and the insurance paid! I light them up each morning as I check my email..

    - susan

  • November 18, 2008 1:51 p.m.

    My SAD symtoms were greatly improved by increasing my intake of vitamin D.

    - Ellen

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