Tuesday, December 02, 2008

A Season for Sadness?

For as long as she could remember, Mary had bought winter clothes two sizes larger than her summer ones. As soon as the weather turned cold, she found herself craving rich, creamy foods and sweets. By Christmas, she was usually five pounds heavier than she’d been at Halloween. By the end of the holidays, she’d put on another five. "I just can’t control my appetite," she told a friend. "Then I get so depressed about being fat that I feel miserable for months."

In fact, Mary not only looked different in the winter, she acted differently. In the summer she was full of pep, spending as much time as she could out in the sun. In the winter, she holed up inside the house for entire weekends. Her husband once described her as "the original couch potato." It wasn’t that she didn’t want to get up and do things-she couldn’t. She didn’t have the energy. Her nerves also seemed more on edge. "Don’t mind mom," she heard her son tell a friend when she yelled for them to lower the volume on the TV. "She’s just in one of her moods."

As she began her annual countdown to spring, she once told her husband, "I’d rather be off hibernating," She couldn’t wait for the first crocuses to push up through the earth. Whereas she usually didn’t feel like fussing over Christmas, she celebrated Easter in grand style. And even though she cooked up a storm, she usually was able to curb her appetite and start losing weight. "Just getting ready for swimsuit time," she’d laugh.

One winter Mary’s family decided to give themselves a special Christmas present: two weeks in Florida. "None of my clothes will fit," she wailed. But when she got into the sunshine, she started feeling so good she didn’t care. As if it were as easy as taking off a heavy coat, Mary shed her winter gloom. The vacation was one of the happiest times of her life. But after returning home, her spirits sank.

A few weeks later, Mary’s seventeen year old grandson, working on a research paper, came across an article on a specific type of depression that strikes mainly in winter. "Read this, Mom Mom," he said. "It sounds like you." As Mary read the article she had to agree that the description of seasonal affective disorder fit her perfectly. The piece included an address for the National Institute of Mental Health, and Mary wrote away for more information on SAD. She also talked to her doctor, who referred her to a psychiatrist in town. His recommendation: phototherapy, or daily exposure to bright light.

Mary purchased a specially designed light box, which she set up in her kitchen next to the table where she read the newspaper in the early morning. Later in the day, she rearranged her easy chair so that her seat was closer to the window. She took daily walks to get the benefit of whatever sunlight there was. She felt lighter, more energetic and her food cravings diminished. And although she still waited eagerly for the first flowers of spring, she felt relieved that winter had lost its terrible hold on her spirits.

Light therapy has been endorsed by medical circles and therapists worldwide as an effective treatment for the depression associated with SAD. The range of specific application is vast and the research continues.

In addition to treating SAD, light therapy -- also known as phototherapy -- has been found to be helpful to elderly patients with dementia or Alzheimer's syndrome. It is known that melatonin levels decrease as we age and there is a syndrome common in the elderly that is called "sundowner's syndrome." In winter months and summertime alike, when the sun goes down those with Alzheimer's or dementia can become sullen, depressed anxious or morose as darkness approaches.

A spectrum of light appliances designed for use in treating SAD is available on the market today.

In a recent study called the Heart and Soul Study, scientists looked at over 1000 people with stable coronary heart disease, followed for almost five years, measuring depressive symptoms at baseline in relation to subsequent heart failure, MI, stroke, transient ischemic attack, or death.

It has long been known that depression is known to increase the risk of heart disease. The study found that if you increase exercise in depressed patients, you're going to reduce their risk of heart disease. But the thing to remember about depressed patients is that they are that much less motivated to do things, so it takes extra effort to get them to exercise, take their medications, and stop smoking.

Take home points: light therapy and exercise will go far to decrease the winter blues.