The Doctor Is In

By Damon Raskin, M.D. | Special to the Palisadian-Post

Q:My friend claims that, now that we are in fall, she is suffering from seasonal affective disorder. As she lives here in the Palisades, which is not exactly Alaska, I find it strange. Is there an easy way to tell the difference between physical and psychological or even neurotic disorders?

School is in full swing, the temperature is cooling off a little and you are starting to see Halloween decorations in all the stores. With these changes, the sun is also setting a little earlier and earlier each evening, and soon daylight saving time will end.

Seasonal affective disorder (SAD), also called “winter blues” or “winter depression,” is a real condition where people who have normal mental health through most of the year develop recurrent depressive symptoms at the same time each year.

I have a young, healthy, male patient who I have known for many years who figured out there was something wrong when, every fall, he didn’t want to do his usual exercise routine. He became more irritable and had more fights with his wife, his appetite changed and he didn’t feel as productive at work. He also didn’t feel refreshed when he awoke in the morning. Untreated, his symptoms got progressively worse as the winter progressed.

Although it is true that the prevalence of SAD is higher in Alaska during the winter than in Florida, this condition still occurs here in Pacific Palisades. Yes, we still have many sunny days here during the fall and winter, but there are still fewer hours of daylight, and for those patients with the predisposition and the brain chemistry, that is all it takes.

The reduced level of sunlight causes changes in the biological clock, decreasing serotonin levels, which affect mood, and changing melatonin levels, which play a role in sleep patterns and mood as well.

The answer to your question is that there is not an easy way to determine whether a patient is suffering from a physical or psychological disorder like this. First and foremost, see your primary care doctor and give them a detailed history of symptoms. I will do a thorough physical exam and often do bloodwork to exclude other medical causes of mood disorders, such as thyroid conditions or vitamin deficiencies.

The key to this diagnosis is really the history that the person’s mood changes with the same season every year and then improves as the season changes.

The treatment for SAD can be as simple as a light box where the sufferer exposes themselves to 30 minutes of light from this special box that generates a particular wavelength of light daily. Symptoms can remarkably improve within a few days to two weeks. The lightbox is generally safe and very effective for this condition.

Other treatments include antidepressant medications or psychotherapy. Once a person is diagnosed, you can even start the treatment just prior to the season where it usually begins to head off the symptoms before they start. My patient does just that, and he is completely free of the condition and stops his treatment in the spring.

So, yes your friend may be “neurotic,” but that doesn’t exclude that they may also truly have this interesting and potentially debilitating condition. Send them love … and light.