by Barbara E. Cohen

Has winter got you down? You might have more than a simple case of the blues. In fact, you might have a medically recognized condition known as Seasonal Affective Disorder, or SAD.

Nearly 10 million Americans suffer from SAD, and more than 14 percent of the adult U.S. population suffers from a lesser form of the disorder, known as subsyndromal SAD, or "winter blues."

Many people experience a slight depression and lack of mental concentration in the winter. In fact, as much as 6 percent of the U.S. population experiences noticeable seasonal changes in mood and behaviors.

But SAD is far more than just an emotional reaction to the shorter winter days. People with severe SAD suffer from debilitating seasonal fluctuations in their energy level, sleep patterns, eating habits, body weight, mood and mental acuity. Some say they feel like hibernating through winter.

Diagnosing clinical or subsyndromal SAD is a challenge for your doctor because the symptoms can be mistaken for other forms of depression. Have you ever been in a winter slump? Your doctor might ask you to take the Seasonal Pattern Assessment Questionnaire to learn if your symptoms are severe enough to warrant medical attention.

Dark Days

Do you shy away from parties and frequently miss work in the winter? Many SAD sufferers report feeling socially isolated and shun contact with others. Although people joke about needing to recover after the holiday social whirl, for those with SAD, the desire to withdraw is no joking matter; it affects their business and personal relationships.

For example, one woman diagnosed with SAD noticed that her personal relationships often ended during the winter. If she met someone in the fall, the momentum of the new relationship carried her through the first winter. But by the beginning of the second winter, she couldn't sustain it. The pattern of winter breakups - coupled with other signs of winter withdrawal and lethargy - was instrumental in her diagnosis, which eventually led to proper treatment. Now, although not cured, she's able to manage the seasonal fluctuations in her mood brought on by SAD.

Does your mental concentration diminish in the winter? For people in creative jobs, seasonal variations in their ability to concentrate and think creatively sometimes hamper their careers. Productivity also falters.

Employees with SAD may be fired in the winter because they can't perform tasks that are no problem for them during warmer months. Unemployment causes them to spiral further into depression, although by spring they find work and can perform their jobs well.

SAD sufferers also can demonstrate sleep issues. Many patients report sleeping for as many as 12 hours a night in winter, although in warmer months they operate on as little as four hours of sleep.

Do you have strange food cravings as winter approaches? People with mild or full-blown SAD report erratic shifts in eating habits. Starting in the fall, they gorge on sugary and starchy foods, and they traditionally put on weight each winter that they lose during the summer months.

The range of symptoms can be mild to disabling, depending on if and to what extent the symptoms interfere with your life. And the problem doesn't just exist during the lethargic winter months. Some people with SAD experience "hypomania," or an excessive energy level during the summer, which can be as disruptive as the lethargy.

Many patients feel like Dr. Jekyll and Mr. Hyde during the course of the year: They are affable and gregarious in the summer months, withdrawn and antisocial in cold weather. Such strong fluctuations in temperament are four times more likely among women than among men.

The causes aren't entirely clear, but research has shown that seasonal changes in the production of the hormone melatonin are probably to blame. Normally, melatonin controls biological rhythms established long ago in our evolutionary development.

For people with SAD, an overabundance of melatonin leads to the winter lethargy and hibernation-like activity levels. Treatment involves regulating the production of melatonin to levels that don't interfere with the activities of daily life.

Lighten Up!

There are no simple tests to determine whether you have SAD. But because treatment choices depend on a correct diagnosis, it's important to consult a physician if you suspect that you are suffering from it. Before self-treating, have a doctor rule out any physiological cause for your weight gain, loss of mental concentration or fatigue. Because the symptoms mimic some bipolar behaviors, it is also important to make sure you aren't suffering from depression or another psychiatric disorder.

Standard treatments for SAD fall into four categories: light therapy, psychotherapy, medication and behavior modification.

Light therapy, also called phototherapy, is used to replace some of the light that SAD patients miss during the winter months by means of an artificial light box or by spending more time outdoors. Going outdoors on bright days and taking a mid-winter vacation closer to the equator are good strategies, although the beneficial effects of a tropical vacation wear off after just a few days.

Therefore, many SAD patients use a light box - containing ordinary white fluorescent light bulbs behind an ultraviolet (UV) filter - at work or at home for as few as 20 minutes or as much as 90 minutes a day. Set the light box on a table or desk so that the light enters your eyes indirectly. Skin exposure alone is not effective, according to Mayo Clinic. If you try a light box, it will take one or two days to notice the effects. Beware of excessive exposure to light therapy, which can overstimulate you.

When SAD is severe or disabling, withdrawal from normal social interaction can lead to depression. Psychotherapy is used to treat any symptoms of depression or other psychiatric disorders that might also occur.

According to Dr. Norman E. Rosenthal, one member of the team responsible for the development of the criteria by which SAD is recognized, there is no reliable method for identifying the best antidepressant for a particular patient. Among the medications prescribed are the selective serotonin reuptake inhibitors (Zoloft, Prozac, Paxil, Luvox) and bupropion (Wellbutrin).

Although many of the symptoms of SAD look like depression, antidepressants are not always the answer. They can have unacceptable side effects that make symptoms worse, such as increasing levels of fatigue and disrupting sleep patterns even more.

Herbal remedies include St. John's Wort, which has been used for at least 350 years for its reputed antidepressant properties. Vitamins D and B12 have also been suggested as beneficial. Planning for seasonal variations is also effective for dealing with the highs and lows that patients with SAD experience all year long.

If you know your energy level is going to decrease as the days grow shorter, you can, to some extent, plan for the change.

Wintertime doesn't have to be depressing. With the right diagnosis and treatment, you can reclaim your energy and enjoy life all year long.

FAQs

Q What are the best winter getaway spots for soaking up the sun?

A Although Florida laid claim to the title of "the Sunshine State," the desert Southwest actually has more hours of sunshine throughout the year. According to the Association of British Travel Agents, average Brits head to the Canary Islands or Spain for their midwinter sun. But they're only likely to get six hours, on average. A better location for long hours of warm sunshine in the winter is Australia, which enjoys its summer while North America is shrouded in its winter funk. And although it's a little hard to get there, at the South Pole the sun rises on Sept. 23 and doesn't set again until March 21.

Q Will my insurance company cover the cost of treatment for SAD or subsyndromal SAD?

A Although the American Psychiatric Association first recognized SAD in 1984, some insurance companies do not reimburse for light therapy because it is considered experimental. Check with your insurance provider about eligibility if you are diagnosed with SAD.

Q Can I claim my winter vacation to Tahiti as a medical expense?

A It's highly unlikely that the Internal Revenue Service will allow you to deduct the cost of a multiweek trip to the tropics as a medical expense, unless you can get your doctor to back you up. However, consider taking a job at a vacation destination, especially a position that allows you to lounge on deck for a few hours of sunshine each day.

Freelance writer Cohen happily hibernates all winter in her office, waiting for the first daffodil sighting in spring.

Article appears as published in the St. Louis Woman Magazine December 2004 issue.