Dr. Jones: It is really dark in the morning these days. Fall has beautiful colors and the days can be gorgeous, but they're getting short. Are you sad about that?
Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.
Dr. Jones: Shorter and darker days in the northern latitudes affect mood for many people. About 1 in 20 people experience seasonal variation in depression, with fall and winter showing a rise in depression. Of those people who are affected with seasonal depression, four out of five are women. This condition has been called Seasonal Affective Disorder, appropriately shortened to SAD syndrome or Seasonal Depression.
In the extremes of latitude up near the Arctic Circle, the winter is associated with increased risks of suicide and the summer with light all day, and night has been associated with increased mood, even euphoria, really increased good mood. Symptoms of SAD include feelings of depression, worthlessness, low energy, and lack of interest in things you usually like to do. Other symptoms and behaviors are a sense of fatigue leading to oversleeping. Spending longer times under the covers with longer, dark days is common. Some women describe carbohydrate cravings, which if you give way to eating those Halloween candies and Christmas cookies can lead to fluctuating levels of glucose which can complicate mood stability and of course can add to seasonal weight gain, which is depressing.
Symptoms start in the fall and get better in the spring. This problem was independent of income and lifestyle factors. According to the National Institutes of Mental Health, the main risks for seasonal effective disorder are age, sex, history of depression, and distance from the equator. The condition seems to start in women in their 20s and 30s.
Why women are so much more likely to be affected isn't well understood. Some researchers have suggested that reduced sunlight can affect serotonin levels, a brain hormone that affects mood. Fluctuating estrogens, which women have and men don't so much, also affects serotonin. Also melatonin, a brain hormone produced in the dark can increase in dark days and adversely affect our sleep-wake rhythm. It can upset our circadian rhythms, which can be associated with depression. So if this is you, what to do?
Number one is phototherapy or bright light therapy in the mornings, and this has been shown to be effective in decreasing symptoms in up to 85% of women with Seasonal Affective Disorder. Now, this is really bright light, brighter than any light bulb, especially now with our new light bulbs. Special devices that deliver 10,000 lux. Lux, L-U-X, is a measurement of light. They are not very expensive and can be bought on the web for about $50 to $100, and some are more expensive than that. Make sure that the light box is designed to treat Seasonal Affective Disorder. You can search light box for Seasonal Affective Disorder and add 10,000 lux to the search term.
This bright light is like medicine. It can suppress melatonin, so it should be used in the morning. Sit about two feet away from the light box for 20 to 90 minutes while reading or doing some work. The light is bright, but don't put your sunglasses on. The UV light that might damage your eyes has been filtered out with these light boxes, so the bright light doesn't damage your eyes. If you find that you're getting out of bed later and later in the fall, using morning bright light therapy will help reset your biological clock so you can get up earlier.
Number two, go outside and get some natural light. In most of the western U.S., we have lots of light in the winter. It's often cloudier in the northeast and the north central states, so it can be harder to find natural, bright light, but just getting outside and going for a walk can make people feel better.
Number three, exercise makes you feel better. Even when it's the last thing you want to do, make an appointment with a friend or a kid and get some exercise. Regular exercise, especially early in the day, not before bedtime, has been shown to help regulate circadian rhythms, which can be important in treating SAD.
Number four, eat this, not that. Try to limit the sugar swings associated with high carb foods and sweets. This is the time to eat your protein and veggies. If you aren't getting enough vitamin D in the winter, which most of us won't because we live in northern cold climates and bundle up, leaving nothing exposed to get our natural vitamin D, you can get vitamin D naturally in fatty fish like salmon and in eggs. Some studies suggest that people with SAD are low in vitamin D and omega-3 fatty acids. Increasing sources of these in your diet is good for your heart and your brain anyway.
Number five. If you know that you're vulnerable to depression and decreased mood in the fall and winter months, get started early on activities and interventions that can help. Don't wait until the darkest days of your mood. Bright light therapy and planned diet and exercise changes early in the fall.
Six. My favorite recommendation is to change your venue. Go south, visiting climates that have more sun. Of course, this can be expensive and disruptive to the family, Thanksgiving and Christmas if mom bugs out to take a holiday on the beach, but it's just a thought. Of course, cranking up the heat in the house, getting a beach blanket and your shorts and sitting in front of a $50 light box is much cheaper, but not so much fun.
Finally, and importantly, this fall and winter holidays can be stressful for women. If you're already struggling with depression, substance abuse, anxiety and the dark days are making it worse, reach out for help to family, friends, and your clinician. You may not believe it in the dark days of your mood, but we can make it better. I'm off to dig up my light box. Thanks for joining us on The Scope.
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