Reduced daylight during the winter induces cyclical depression.
More than 30 years ago, Norman Rosenthal, author of Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder, conducted a study commissioned by the National Institute of Mental Health (NIMH) to examine the psychological changes some individuals experience as the seasons change. His findings determined that months with the least amount of daylight induced recurrent and cyclical depression in some people, a condition called seasonal affective disorder (SAD).
The Center for Behavioral Health at the Cleveland Clinic reports that half a million individuals in the United States experience SAD and between 10 and 20 percent experience a milder form of the illness, commonly known as cabin fever or winter blues. While less debilitating, the latter might require some intervention until the amount of sunshine increases.
What’s the difference?
George Brainard, PhD, director of the Light Research Program at Jefferson University in Philadelphia, and professor of neurology, explains that SAD and the winter blues, which is a subsyndromal form of SAD (S-SAD), feature similar symptoms but vary in degree. “The diagnosis for SAD is clinical depression severe enough to compromise the ability to handle jobs, take care of family and self and requires serious intervention,” he says. “Winter blues or cabin fever have some of the same symptoms, but the person is still coping with life.”
According to Brainard, typical depression might occur at any time of year and could involve loss of pleasure in everyday activities, physical and emotional fatigue, weakness, low energy, inability to concentrate and diminished libido. The individual may also have a decreased appetite, leading to weight loss, and hypersomnia, an increased drive to sleep, although quality and time sleeping may be diminished.
Winter blues, on the other hand, is calendar driven. “It’s an annual recurrence that happens, by far, during the short days of fall, winter and early spring,” says Brainard. To confirm diagnosis, the blues must occur at least two years or more in a given season, he adds. “There is also intense craving for carbohydrates and high-energy foods. People often gain a substantial amount of weight, much like a bear in hibernation.”
Help is available
Medication and cognitive behavioral therapy (CBT) are typical interventions, according to Brainard, but one of most widely used, and effective, treatment options for the winter blues is light therapy. “There’s no arguing that light therapy is successful in 60 to 80 percent of patients,” he says. “You have to take a drug for three weeks before there are any symptom changes. Light therapy can begin working within days, certainly within a week or two.”
Typically, patients should get 10,000 lux of bright white LED or fluorescent light for 30 to 45 minutes as early upon waking as possible. “The FDA doesn’t regulate light therapy because the risks are so minimal and the benefits are well established in biomedical research,” Brainard says.
Recently, Brainard’s clinic conducted a study and found that blue LED light with 400 lux was just as effective as therapy with 10,000 lux. He emphasizes that the research is still in the early stages though and points out that all patients may not respond to light therapy. For those who are photophobic, the intense light might cause eyestrain or headaches. A good option is a walk outdoors at dawn, according to Brainard. “It provides 10,000 lux, the same dose of light [obtained] from the sky.”
Tell your patients with the winter blues, take heart—the sun will return in due time.