SAD

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Seasonal affective disorder (SAD) is a mood disorder characterized by periods of depression that begin in the fall and subside in the spring. It results from the decrease in sunlight during the shorter days. The threshold of light-reduction that elicits depression varies among individuals.

The depressive episodes are usually mild to moderate but can be severe.

Approximately 10 million Americans experience SAD. Another 25 million may have a subclinical response ("winter blues"). Seventy-five percent to 80 percent of SAD sufferers are women who typically begin experiencing the disorder in their 30s. SAD has also been observed in children.

Seasonal affective disorder occurs more frequently in northern regions because of the shorter winter days.

The key factor in diagnosing SAD is its seasonal pattern: Symptoms fade with the arrival of spring and return in the fall. Another characteristic of the illness is a craving for foods rich in carbohydrates.

Symptoms include lethargy or fatigue, weight gain, withdrawal from relationships, decreased sexual appetite, inability to concentrate or focus, irritability, anxiety and occasionally despair.

Women frequently report worsening of premenstrual symptoms.

The primary treatment for SAD is light therapy. Other treatments, such as antidepressant medication, stress management, exercise and psychotherapy, may be useful as well.

Light therapy is exposure to intense levels of light under controlled conditions. The typical light therapy system consists of a set of fluorescent bulbs in a box with a diffusing screen. The box is placed on a table, and the person with SAD sits close to the light box, with lights on and eyes open. However, looking at the lights is not recommended; rather, people should engage in activities such as reading or eating meals.

Spending time outdoors during the day or rearranging the home and workplace to admit more sunlight may help alleviate mild symptoms.

If light therapy is not effective, an antidepressant drug may reduce or eliminate SAD symptoms.

The National Institutes of Health recently initiated a study of the efficacy of St. John's wort in treating depression. This study has implications for the treatment of SAD as well. St. John's wort (Hypericum perforatum) is an herb widely used in Europe to treat depression.

To lessen the symptoms of SAD or winter blues:

• try to develop a positive attitude about the fall and winter
• plan enjoyable activities for the fall and winter
• maximize the time spent in bright light, both indoors and outdoors
• stay physically active or initiate physical activity before the onset of symptoms
• eat a well-balanced diet