Feeling more down than usual and wondering how to get out from under the grey clouds of winter? It might be the weather, but if you’re experiencing symptoms that affect your daily life, it could be something more. Dr. Richard Nockowitz from the Ohio Hospital for Psychiatry sheds some light on seasonal depression, also known as seasonal affective disorder.
What is seasonal depression and what causes it?
Seasonal affective disorder is simply a mood (affective) disorder that has a seasonal pattern to it. It typically occurs in the winter months, beginning in late fall/early winter and ending in late spring/early summer. Less commonly, depression can occur in summer rather than winter months. The main characteristic is a predictable, yearly seasonal pattern to the mood symptoms.
The definitive cause is not known, as is the case for nearly all mood/psychiatric disorders, but there are many theories. For seasonal mood disorders, changes in circadian rhythm, serotonin levels and melatonin levels are all thought to contribute. One interesting theory is that it’s not the change in the duration of daylight one is exposed to (shorter days during the winter), but rather that the intensity of the light is diminished during the winter months. There are cells on the retina (back of the eye) that are sensitive to light, and the lower intensity light (measured in lux) does not stimulate those cells adequately, causing a change in brain chemistry leading to these mood symptoms.
What are symptoms of seasonal depression? What should I look for in myself or my loved ones?
To meet the conditions necessary for diagnosis, one must have five of the following nine symptoms at least 50 percent of the time during a minimum two-week period of time. Symptoms include either depressed mood or loss of interest and enjoyment in usual things, plus at least four of the following seven symptoms:
- 1. changes in sleep (more or less);
- 2. increased guilt and negative feeling, or some degree of hopelessness and helplessness;
- 3. decreased energy;
- 4. poor concentration or absent-mindedness;
- 5. change in appetite (increased or decreased);
- 6. slowed down thinking and movement, or increased thinking and movements/restlessness; and
- 7. thoughts of death or wishing to not be around any longer.
When the above criteria are met, it is absolutely necessary to see a doctor for further evaluation and possible treatment.
What types of treatments are available for this disorder?
Medication is going to be necessary, as this is a biological condition. Light therapy (phototherapy) is sometimes helpful as well, but be aware that it is a specific intensity of light (certain amount of lux) and very specific intervals and durations. Going about light therapy improperly can actually make the condition worse.
How does phototherapy work?
Exposing the retinal cells to a higher intensity and spectrum of light at specific intervals and durations can alter brain chemistry. The light is usually delivered using a “light box” that is specifically designed for such use. A person would sit in front of the light box, at a specific distance, while reading or doing normal tasks at the prescribed time of day and for the prescribed amount of time.
Blood levels of the light-sensitive hormone melatonin, which may be abnormally high at certain times of day, causing tiredness and other symptoms, are rapidly reduced by light exposure. Serotonin levels, which are central to the regulation of mood, are also affected by light stimulating cells in the retina. Also, the pineal gland – the body's internal clock that controls daily rhythms of body temperature, various hormone secretion, and sleep patterns – is affected by the timing of bright light exposure.
A small number of patients can experience side effects including headaches, eyestrain or eye irritation, or nausea at the beginning of treatment. These are usually mild and usually abate after a few days. Of greater concern, although it doesn’t occur often, is that some patients’ mood state and other symptoms can worsen – switching to an overactive state, during which they may have difficulty sleeping, become restless or irritable, and feel "too high."
Should phototherapy be done under the care of a physician?
Definitely. It is important for the treatment to be prescribed and monitored properly, as one would with medications. Questions need to be asked before starting treatment to determine if the diagnosis is correct, to make sure this is an appropriate treatment for you, and to prescribe what time of day and for how long you should utilize the light therapy, depending on your symptoms.
Can seasonal depression be prevented?
Not necessarily. Mood disorders are biological conditions that will occur in those genetically predisposed to having them. However, if you have used medication or light therapy for your depression, you may be able to prevent a recurrence by starting or staying on these treatments at the time of year when you would normally become symptomatic.
Bio
Dr. Richard Nockowitz
Dr. Richard Nockowitz, M.D., received his medical education at the Albert Einstein College of Medicine in New York, followed by training at Harvard Medical School’s Massachusetts General Hospital in Boston. There, he completed a clinical fellowship in medicine, a general psychiatry residency and a fellowship in consultation psychiatry. In 1997, he went to The Ohio State University Department of Psychiatry to serve as chief of the Psychiatry Consultation Service for OSU Hospitals. Since then, he has been in private practice, lecturing around the country about psychiatric conditions and treatments and working as a medicolegal expert in psychiatry. He is the medical director of Ohio Hospital for Psychiatry and is founder and medical director of My Psychiatric Partner, LLC, www.mypsychiatricpartner.com, a telepsychiatry service that utilizes videoconferencing to provide psychiatric care in various medical settings and directly to patients at home. Nockowitz has expertise in the areas of the medical-psychiatric interface, neuropsychiatry, dementia and delirium, and complex partial seizures, and has authored numerous book chapters on depression and suicide, psychopharmacology, and enhancing patient compliance.
