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Seasonal affective disorder a problem even in the sunny Southwest

As cooler weather and shorter days set in, some may feel lethargic and see their drive for work and social activities diminish. Millions of Americans suffer what is often referred to as the “winter blues” this time of year.

For most, these are minor lapses, but for others, this seasonal mood change may be a more severe form of depression known as seasonal affective disorder, or SAD.

“This is a major depression that may even lead to not functioning well, not earning an income and even suicide,” said Rhigel “Jay” Tan, a psychiatric nurse practitioner and assistant professor in UNLV’s School of Nursing.

ABOUT SAD

In the early 1980s, Maryland-based psychiatrist Norman Rosenthal gave the disorder its name. He is the author of the seminal work, “Winter Blues,” which is now in its fourth edition and considered the authoritative piece of literature on the subject.

“I think the first surprise is just how many people have the condition,” Rosenthal told the Review-Journal. “But this very often falls under the radar, as clinicians and doctors aren’t looking for it. It goes undetected.”

With SAD, levels of the body’s natural mood enhancers such as melatonin, dopamine and norepinephrine become compromised as a result of their sensitivity to daylight and nighttime, Tan explained. With less sunlight available in the fall and winter months, naturally, levels drop, leaving a person more vulnerable to depression symptoms. Modern industrial society’s natural construct, where the workday keeps many inside during sunny hours, can make matters worse, added Dr. Matthew Carlson, an assistant professor at Touro University Nevada’s Family Medicine program.

Some of the common symptoms associated with SAD include: feelings of hopelessness, despair, lethargy, avoidance of social contact, and cravings for sweets or starchy foods, which can also be accompanied by weight gain. In extreme cases, patients have a hard time functioning in work and social settings.

Carlson said SAD sufferers have truly depressive symptoms, not just what some may call “off days.”

“It’s more than just feeling down,” he added, “and the symptoms must occur for at least two consecutive years.”

There are rare cases where patients experience the symptoms in the spring or summer, but most cases occur in the fall and winter seasons. Even with 300-plus days of sun, desert dwellers are not immune to the condition. Those with SAD often carry a hereditary gene, Tan also noted.

“Las Vegas is a melting pot of people from different places. Many think their depression will get much better when they move here, but it still manifests with seasonal changes. … The switch of the season is still programmed into their biologic routine,” the expert said.

MILDER FORMS ARE STILL SIGNIFICANT

Rosenthal said much of the attention SAD receives focuses on extreme cases, but there are so many milder cases that may still bring serious compromises to life.

“These people are less enthusiastic, less creative, have a hard time keeping up with commitments, deadlines, projects. … Nothing I’ve said would stick out as ‘Gosh that person has a disorder!’ It just goes under the radar and it’s shrugged off as them not being as sharp as usual,” he added. “But something that takes 10, 15, 20 percent of your functioning can become rather important.”

TREATMENT, LIFESTYLE CHANGES, LIGHT THERAPY

Selective Serotonin Reuptake Inhibitors (SSRI) such as Paxil, Zoloft and Prozac can be prescribed for SAD sufferers, but many psychiatrists, psychologists and other medical professionals recommend attacking the problems with lifestyle changes first.

The three experts interviewed for this story all agree that getting outside during daytime hours is critical, as well as maintaining a healthy diet and exercise program. Carlson also says it’s important for patients to force themselves to try to stay involved with social groups, even if the instinct is to stay away.

“A brisk walk on a sunny day can do wonders,” Rosenthal added.

For more formalized treatments, Rosenthal recommends light therapy combined with cognitive behavior therapy conducted by a trained psychologist. Light therapy involves exposing the eyes to light, often in the form of light boxes, several times throughout the day. There are many different types of light boxes on the market, added Carlson, and they come in a variety of light intensities, but all are regulated by the FDA.

Some studies have found a more than 80 percent success rate in symptom improvements for SAD sufferers, Carlson added. He also recommends supplementation with vitamins B and D.

“In Europe, vitamin D is even seen as a first-line treatment,” Carlson added.

Tan encourages those concerned about mental health stigma to seek help anyway.

“A lot of people never seek help before the light switch goes on. They realize they don’t want to talk to people and something doesn’t feel right,” Tan explained. “But when it affects a change in day-to-day routine or productivity, you must seek help.”

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