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Sun November 17, 2013
Health

Why so SAD?

Winter in central and northern New York isn’t always as picturesque as some may wish it to be. Daylight is usually gone before the work day is over, flurries have the potential to make any drive difficult, and gray skies often seem like they’re never going away. It’s normal to feel off when the days get shorter, but what happens when these feelings manifest into something much more serious on a yearly basis?

This week on Take Care, Dr. Kelly Rohan discusses the causes and treatments of Seasonal Affective Disorder (SAD). Rohan is an expert in SAD and acting director of clinical training in the Department of Psychology at the University of Vermont.

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With such a literal acronym, some may not realize how serious a disorder SAD is. Rohan defines it as, “a subtype of depression that tends to come back every year, and it involves experiencing major depression in the fall and winter months that fully remits, or goes away, in the summer months.”

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SAD usually strikes for up to five months at a time (usually starting in September), and can yield many serious symptoms. These may include feeling sad and tired, losing interest in everyday activities such as socializing or work, feeling guilty and having low self-esteem, and moving around “as if in slow motion.” In the most severe cases, thoughts about death and suicide may occur.

While it varies from person to person, there are many reasons someone could develop SAD. Rohan says that women are more likely to suffer from it than men, and that the mean age of onset is in the early 20s.

Location, according to some studies, could play a large role. A correlation has been found between latitude and SAD development. Essentially, the farther away someone is from the equator, the more likely they are to develop SAD. That’s because the days are longer in locations closer to the equator.

“Simply, the number of hours from dawn to dusk, the number of daylight hours, seems to be the biggest predictor of SAD onset, as well as how severe the symptoms are in any particular day, more so than how much light is available, in terms of true sunshine, or luminosity, or how bright the light that’s available is,” says Rohan.

Treatment for SAD takes many forms. One kind of treatment is “bright light therapy,” which involves exposing patients to a certain wavelength of light for a prescribed period of time. Rohan says clinical trials have shown that this works effectively about half of the time.

The kind of treatment Rohan specializes in is cognitive-behavioral therapy (CBT), which she believes is “helpful in terms of teaching people new ways to cope specifically with the winter season.” Just like the name implies, CBT focuses on changing both thoughts and actions towards the fall and winter season.

In the cognitive part, “we identify and try to challenge to change negative thoughts that are associated with depressed mood. Some of the thoughts are about the winter season itself—how short the days are, weather related thoughts, thoughts about snow and shoveling snow. We work on those kinds of thoughts and try to make them a bit less negative and a bit more positive,” says Rohan.

In the behavioral part, “we use techniques like trying to get people activated and engaged as opposed to withdrawing and retreating. So, identifying winter time interests— things that could be antidepressant in the winter such as social activities, joining clubs, reading, artwork—whatever it is the person is interested in,” she says.

The final part of the therapy is relapse treatment, teaching patients “how to use the skills in future winters to try to fortify oneself against future SAD episodes.”

Rohan believes this approach is effective due to its proactive nature. “We know exactly when the symptoms are going to start,” Rohan says, stressing that early treatment is key and possible with CBT.

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