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What you need to know about seasonal depression

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The fall and winter months often herald the season of celebrations and holidays. But for many, the darker, colder days herald a different kind of period: a period of fatigue, lethargy and depression.

Seasonal affective disorder, or SAD – a form of depression that occurs with the changing of the seasons – can affect up to 10 percent of people in the United States, depending on where they live. Here are some of the most frequently asked questions about seasonal affective disorder, with answers from experts.

“One big, common misconception about SAD is that it’s just the ‘winter blues,’” says Kelly Rohan, professor of psychological sciences and clinical psychologist at the University of Vermont. When the days become grayer and colder and the holidays approach, it is not unusual to experience temporary feelings of malaise, fatigue or stress. But seasonal affective disorder is much more serious — a form of clinical depression, Dr. Rohan said — with symptoms that can last longer and come and go with the seasons.

According to the National Institute of Mental HealthYou may be suffering from seasonal affective disorder if you experience certain symptoms that start and end during specific months and occur for at least two consecutive years. These may include near-constant and daily feelings of depression, loss of interest in activities you used to enjoy, changes in your appetite or weight, sluggishness and low energy, difficulty falling asleep or oversleeping during the day, or even thoughts of death or suicide. .

Most people with seasonal affective disorder have winter pattern SAD (or winter depression), in which symptoms begin in late fall or early winter and resolve in spring and summer. But SAD can also occur during the spring and summer months, called summer pattern SAD (or summer depression).

SAD is much more common in women than men, and in those who live in northern regions of the United States – such as Alaska or New England – than in those who live in southern regions, such as Florida. It can sometimes also run in families.

“People may not realize how seriously SAD affects someone,” says Dr. Paul Desan, a psychiatrist at the Yale School of Medicine. For some people, he added, “their lives come to a standstill for six months.”

For people with winter SAD, shorter, darker days are the cause of depressive symptoms, said Dr. Rohan. But experts don’t know exactly why this happens.

A leading theory has to do with a shift in the biological clock. Normally, the body produces melatonin at night, which promotes sleep. When melatonin levels decrease as sunrise approaches, it helps people wake up. But if you suffer from winter blues, melatonin peaks later and lingers longer in the morning, making it harder to wake up and leaving you tired and dizzy. Because you don’t reach peak alertness until later in the day, it’s harder to fall asleep as evening arrives, perpetuating a cycle of insomnia, insufficient sleep and fatigue, and exacerbating depressive symptoms.

Most people who are vulnerable to SAD are most likely prone to feeling down all the time, says Kathryn Roecklein, an associate professor of psychology at the University of Pittsburgh. But in winter the light level drops below a threshold and things are suddenly out of balance.

There is also some evidence that negative expectations of shorter days — for example, thinking “I just don’t function well in the winter” or “I’m going to feel bad soon,” said Dr. Roecklein – can be combined with biological effects to create a self-fulfilling prophecy.

While it can vary from person to person, symptoms of SAD can last a long time — up to five months for some, said Dr. Lily Yan, a professor of psychology and neuroscience at Michigan State University.

Most people with winter SAD will begin to notice symptoms between October and November, said Dr. Rohan. But if you live in parts of the country where people are more sensitive, you may notice them earlier in the fall. Stressful life events, such as instability at work or grieving a loved one, can also trigger depressive episodes earlier than normal.

The most severe symptoms usually occur in January and February, Dr. Yan said. Some experts think this happens because of the accumulated effects of SAD over time, she said. The longer you have complaints, the worse they become. But people tend to start feeling better once spring and early summer arrive.

Symptoms of summer pattern SAD, which are much less common, usually begin in the spring and end around early fall.

The good news, experts say, is that there are several evidence-based ways to find relief.

“Treatment with bright light in the morning improves dramatically in the vast majority of people with seasonal affective disorder,” said Dr. Desan. This involves sitting in front of a light therapy box, which mimics outdoor light, for about 30 minutes every day, immediately when you wake up, preferably early in the morning. This should stimulate your body to produce the right hormones to increase your wakefulness and alertness to help you get through the day, said Dr. Desan.

Make sure you use it correctly. If you don’t use it early enough, it may not work; and if you use it too late in the day, it can worsen insomnia, Dr. Rohan said. Most experts recommend using light therapy lamps before 8 a.m

An abundance of lights won’t do you any good, said Dr. Desan. When looking for a light therapy lamp, you want one with a brightness of 10,000 lux – the equivalent of a bright summer morning. A good light therapy lamp should also be “full spectrum,” he said, meaning it emits light that closely mimics natural morning sunlight. Unfortunately, it’s challenging to know exactly what you’re getting because light therapy lamps are not regulated. To assist buyers, Dr. Desan clinically examined and listed a number of lamps at Yale his recommendations on its website.

If you think you may be suffering from seasonal affective disorder, consult a therapist or psychiatrist before deciding on a treatment plan. They can advise you on the best plan for you — and when it comes to bright light therapy, they can teach you how to do it properly, added Dr. Rohan to it.

CBT, a form of talk therapy that aims to change faulty or unhelpful thinking, can also be helpful, Dr. Rohan said. If you say things like, “I hate winter” during a session, she said, the therapist will try to reposition those negative thoughts. “Even if we could take it down a notch: ‘I prefer summer to winter,’” she said, that could result in a big change in symptoms and mood.

Because cognitive behavioral therapy for SAD involves retraining your negative associations with dark months, it’s the only treatment that might have long-term benefits after doing it just once, said Dr. Roecklein. “It works in the winter when that person comes in for treatment,” she said, “but it also protects them from depression the next winter and the winter after that.”

Seasonal depression can also be treated with antidepressants, such as the selective serotonin reuptake inhibitors fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro).

Bupropion (Wellbutrin), another type of antidepressant, is the antidepressant only drug approved by the Food and Drug Administration to prevent recurrence of seasonal depressive episodes. If you are prescribed this medication for winter SAD, take it once a day from fall to early spring.

If you’re tempted to try certain supplements like folic acid, B12 or vitamin D, don’t waste your money, said Dr. Roecklein. Unless you have a true deficiency, she said, there is “zero evidence that taking supplements” will work for treating or preventing seasonal affective disorder.

Simply getting outside can also help improve your mood, Dr. Yan said. Even if it looks a bit gray, the quality of light on a winter morning will be better than what you can get in your home. And an excursion will most likely improve your mental health, too, she added.

Replacing your favorite summer activities with similar winter activities can “bring a sense of fun into life,” said Dr. Rohan. If your favorite summer activity is lounging by a lake, she said, you can still do a version of that: maybe put on a pair of snowshoes and walk around, or try ice skating or sledding. “It may take some creativity and problem-solving,” she said, but it will help you find a way to deal with the season positively.

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