Q: My sister has always had problems with her mood during fall and winter. We used to joke about it during our Thanksgiving and Christmas dinners, but now I am rally worried about her. She seems withdrawn and does not talk much. I just saw her recently and I almost did not recognize her! She has gained so much weight! Is it true that there is a form of depression related to the lack of sunlight? How do you help it? Does it run in the family? We are three sisters and two brothers, ages 48 to 62. Thank you for your advice. — Helen

A: It seems to me that the problem you describe with your sister may be a form of depression called seasonal affective disorder or "SAD". With seasonal affective disorder, fall's short days and long nights may trigger feelings of depression, lethargy, fatigue and other problems. Many brush this off as simply a case of the "winter blues" that they have to tough out on their own. When severe, however SAD can really impair ones life and make person miserable for months! By definition this form of depression happens cyclically. Symptoms are similar to the symptoms of regular depression and besides the sadness include:

-Hopelessness
-Anxiety
-Loss of energy
-Social withdrawal
-Oversleeping
-Loss of interest in activities you once enjoyed
-Appetite changes, especially a craving for foods high in carbohydrates
-Weight gain
-Difficulty concentrating and processing information

Believe it or not but

Advertisement
there is a summer onset SAD presenting with anxiety, insomnia, irritability, agitation, weight loss and poor appetite. There is also a "reverse" SAD with increased activity and elevated mood (this is very rare and most people do not see this as a problem, but some doctors worry that it is similar to manic episodes in bipolar patients and may be also dangerous!)

No one knows exactly what is the cause of SAD. It is believed that disruption of a natural biological clock we all have (doctors call it circadian rhythm) may play a role. Others claim that with less and less sun light and an increased production of melatonin- natural substance regulating sleep may be to blame. Still others tie SAD with serotonin- a chemical most often associated with depression, since serotonin levels drop with decreased sun exposure. Northern location (think Iceland) of ones household and genetic predisposition are suggested as two strongest risk factors. Women experience SAD more often, but men have usually a more severe course.

How should one decide that "winter blues" is actually a form of depression and that a professional help is needed?

Well if symptoms start compromising daily functioning, work, personal relationships or if they are severe enough to contemplate suicide immediate help is needed. Although SAD is not recognized as a separate form of depression, doctors treat it somewhat differently. Many will recommend increased exposure to light, seating next to the window, long walks and lunch brakes outside.

If possible, regular physical exercise can be very helpful. Some prescribe artificial light exposure and many find it effective, although clinical studies are not conclusive and it is not officially approved as a form of treatment. Medications may help so can psychotherapy (talk therapy).

As far as our part one can try to stick with the therapy, avoid alcohol, stay outside as much as possible, think of relaxing and stress release strategies. Some people will take a trip down south, but even if that is not possible socializing more helps.

You should try to talk with your sister in a loving, caring way. Offer her help and suggest formal evaluation with a health professional.

If you can, become her "outside activities" buddy, exercise with her and take her out to be with friends. Discourage excessive alcohol. Plan a trip together. I did it once with my older sister. Boy, did we have a blast!
Sincerely Dr Bea

Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.