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The winter blues

Posted on 11 December 2013 by Jimmy Yan (Meds 2015)

So let’s take a look at where we are at in the year now, hmmm?

Days getting shorter, check.

Temperature dropping, check.

Clerkship dragging on, check.

CaRMS application milestones, and interview anxiety, check.

Perpetual tide of exams rolling out, check.

Between all that, and having to deal with things like always waking up in the dark, constantly trudging on boots to deal with the biting cold, and the continual all-nighters, it’s pretty understandable to have a case of the “winter blues” . However, often overlooked or disregarded is the more serious condition of Seasonal Affective Disorder, or SAD.

Despite the silly (albeit fitting) acronym, SAD can be quite the serious. It is a recurrent major depressive disorder that follows the pattern of the seasons. According to the Canadian Centre of Addiction and Mental Health (CAMH), SAD is linked to shortened hours of daylight and lessen exposure to sunlight, which do play a role in the brain’s release of melatonin and serotonin, although the exact pathophysiology is not quite clear.

What is more apparent is the symptoms of SAD. These include: lethargy, feelings of hopelessness, increased appetite and weight gain, social avoidance, anxiety, and oversleeping. This can resemble bipolar disorder or hypothyroidism, as well as clinical major depressive disorder. However, the latter is more likely to have insomnia and anorexia.  It is believed that SAD affects women more than men, with 60 – 90% of those affected being female.

But what can be done for those afflicted? The treatment options, listed by CAMH, include antidepressant medication, trytophan supplementation, and light therapy. Antidepressant medication has shown to be effective in treating SAD, fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) being listed as effective in management, and bupropion (Wellbutrin) being used prophylatically. Tryptophan supplementation is believed to increase stores of this amino acid, which is an essential component in serotonin and melatonin biosynthesis. Again these two neurotransmitters are strongly linked in the pathophysiological mechanism for SAD.

Light therapy is quite an interesting treatment option for those with SAD. Light therapy ‘lightbox’ bulbs are upwards of 100x more ‘luminous’ than a normal incandescent lightbulb. Individuals with SAD are to receive daily dosages of 30 min to 2 hrs to help increase the body’s level of sunlight exposure.

Additionally, exercise has been recommended by the CAMH as a means to help prevent SAD, as well as showing a role in boosting therapy and preventing further recurrence. While the physical aspects of being active are at the basis of these recommendations, I suspect that the associated social aspects of being active, such as increased interaction and making personal connections are also an added boon. So if it’s too icy to run on the road, strap on some skates and hit the rink instead!

One important thing to note is that while this article has given a basic overview of SAD, it is not meant to be a be-all-end-all summary to be used in (self) diagnosing the condition. Yes, it’s pretty obvious, but still needs to be mentioned. If there is ever the case where symptoms emerge, do not improve, or worsen, consult a physician immediately.

While the depths of winter, especially when coupled with a harsh academic season, can be difficult to get through, it is incredibly important to maintain our mental well-being while undergoing the trek through the cold season. How many days until spring now?

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