Friday, November 9, 2012
Get Ahead of the Wintertime Blues
Get Ahead of the Wintertime Blues by Kristin Thorson, Fibromyalgia Network Editor Posted: October 31, 2008 Don’t dread the wintertime blues. Get a jump start in heading off the symptoms associated with Seasonal Affective Disorder (SAD). This common mood disorder can begin as early as October or November and persist through March. Symptoms include a depressed mood, loss of interest, low energy, social withdrawal, anxiety, feelings of guilt, cravings for starchy or sweet food, increased appetite, weight gain, and insomnia.1 Patients say that their worst month is either January or February. Many people who experience the winter blues are not aware that they have SAD. They may simply view this seasonal lull in mood as a normal stage that everyone goes through when the days are shorter and the body gets less sunshine. Because SAD is often overlooked, most patients endure roughly 13 seasonal episodes of this condition before getting treated for it. If you experience repeated bouts with depression during the winter and suspect that you have SAD, don’t assume it’s your fibromyalgia and don’t let it compound your symptoms. Effective therapies are available. Because the nights are longer in the winter, the body’s internal clock and its natural sleep/wake cycle shift.2 The body’s clock and sleep/wake cycle are controlled by the pineal gland at the base of the brain. It secretes melatonin when it is dark at night. When the eyes are exposed to light, melatonin production is shut off. Because the sun rises later in the winter, melatonin is secreted longer in the morning. In genetically predisposed individuals, it is suspected to be responsible for the common symptom of morning tiredness or sluggishness that is associated with SAD.3 Two other pieces of evidence that point to a malfunction in the body’s internal clock mechanism have to do with the effective treatment results obtained by using exposure to bright light in the early morning, or a small micro-dose of melatonin taken in the late afternoon to bring the melatonin “cycle” forward in an effort to reduce morning fatigue. Light Box Therapy Using a bright light box for 30 minutes each morning has been shown in studies to be just as effective as taking an antidepressant, such as Prozac.4 In fact, light therapy tends to work slightly faster and produce fewer side effects than Prozac, a selective serotonin re-uptake inhibitor (SSRI) medication that may cause agitation, sleep disturbance, and palpitations. Analysis of light therapy for treating SAD indicates that patients need to use a high intensity box that emits 10,000 lux; “lux” is the light intensity rating of the box. For a 10,000 lux box, 30 minutes of exposure with your eyes open (but not looking directly at the light) each morning is sufficient.5 Boxes with lower “lux” ratings may be cheaper, but more time is needed to get the same effect. Light boxes are not covered by insurance and can be costly. Shop online at superstores like Costco, or a local health products distributor. Prices start around $200. Light therapy may not be as convenient as taking medication, but the side effects are fewer, despite speculation that these devices may cause an increase in eye strain and headaches. Supplements Research is ongoing on the use of a tiny dose of melatonin (0.1 mg) taken in the late afternoon, but so far it appears to work synergistically with light therapy to treat SAD.3 This small dosage does not produce sedation, but it has enough of a physiological impact to signal the pineal gland to reset the body’s clock. The typical over-the-counter doses of melatonin are much higher (e.g., 3 mg), so you would need to seek the help of a compounding pharmacist to prepare the smaller dose formula. This would also require a doctor’s prescription. When the days are shorter, people are at an increased risk of developing vitamin D deficiency. Talk to your doctor. A vitamin D deficiency is easy to identify and inexpensive to correct. Another option might be to visit a tanning salon a couple of days a week for a limited amount of time to make up for the loss of sun exposure and the ultraviolet (UV) rays that help your skin make vitamin D. A small study showed that UV light helped produce natural substances in the body that made people feel better, experience less pain, and improve mood.6 Medication What about preventing SAD episodes from occurring each winter? First, all other medical reasons for depressed mood need to be checked (such as thyroid problems, sleep disorders, lung difficulties, chronic sinus infections, etc.) One study using long-acting Wellbutrin (buproprion) showed that initiating treatment in November and tapering off the dose at the end of March prevented SAD in 50% of patients.1 The starting dose of buproprion XL was 150 mg/day, and if tolerated or needed, was increased to 300 mg/day. Buproprion is less likely than Prozac to cause side effects, with its primary side effect being dry mouth. In fact, if you have restless legs syndrome (RLS), buproprion is the one antidepressant that will not aggravate this sleep disorder. Self-Help Strategies •Avoid becoming “house bound” by going outside each day. •Make a point of keeping your house or apartment well-lit. •If you have a fireplace, try lighting it on cold days; there are certain comforts associated with warm fires. •Be careful not to unintentionally compensate for increased sluggishness by eating lots of sweets. Weight gain will not lift your mood. •Loosely structure your days to have a blend of time spent on yourself, with others, and doing something productive. Lack of structure is a major contributor to feeling down or blue. •If you are not working outside the house, try getting dressed and leaving the house at the same time each day, say, 10:00 a.m. (just like going to work). This is a good opportunity to run errands, shop, and accomplish other duties early. It can help you feel more productive and stave off some guilty feelings. As you get into the heart of winter, create a plan. Everyone thrives on a mixture of people, activities, stimulation, rest, structure, alone time, and time with others. 1.Modell JG, et al. Biol Psychiatry 58:658-667, 2005. 2.Lewy AJ, et al. PNAS 103(19):7414-7419, 2006. 3.Srinivasan V, et al. World J Biol Psychiatry 7(3):138-151, 2006. 4.Lam RW, et al. Am J Psychiatry 163:805-812, 2006. 5.Golden RN, et al. Am J Psychiatry 162:656-662, 2005. 6.Feldman SR, et al. J Am Acad Dermatol 51:45-51, 2004.