Wednesday, January 16, 2013

Feeling Sad & Lethargic? Deciphering the "Winter Blues"

By Michael Henry, MD

Michael Henry, MD,
assistant psychiatrist,
MGH Bipolar Clinic
and Research Program

This time of year, we often hear from patients who say they are feeling rather sad and lethargic. People wonder if it’s normal. We caution folks to not just chalk up their symptoms to the winter blues, and to come in and take a closer look at what’s bothering them. Depending on their symptoms, we might consider a diagnosis of seasonal affective disorder, otherwise known as SAD.

SAD is unipolar or bipolar depression which occurs with a seasonal variation. Approximately five percent of the U.S. population experiences symptoms of SAD each year. SAD is thought to be more common in younger individuals. Data also suggests 60-90 percent of those with SAD are women.

Usually, the depressive symptoms of SAD begin in the fall or the start of winter and remit in the spring. However, there is a less common variant in which the depressive symptoms recur in the summer. The episodes of depression associated with a seasonal pattern are frequently accompanied by very low energy, increased sleep, carbohydrate craving, overeating and weight gain. 

Even if a patient exhibits all of the above symptoms, there are several other possible conditions that should be considered before a diagnosis of SAD is made. Medical conditions such as low thyroid function and low red blood cell counts commonly masquerade as depression.  Drug use and withdrawal, such as the depression and lethargy associated with cocaine withdrawal, are also well known causes of depressive symptoms and should be considered before chalking the symptoms up to the winter blues. 

It is also important to consider whether there are circumstances or events that have occurred in the person’s life that are contributing to the sad mood.  Grief over the death of a loved one can have profound effects on the person’s mood and functioning. It is not uncommon for people to feel the loss of a significant person on the anniversary of their death and at the holidays.  Loss of employment and financial setbacks should also be considered when trying sort out the cause of seasonal depression. 

Fortunately, for individuals suffering with SAD there are several effective treatments available. Some people with mild symptoms have found that a brief stay in sunnier latitudes is quite helpful. It’s the perfect time for a vacation!  For those individuals who do not have the time or the means to for a quick trip, or who are suffering with more severe symptoms, there are several other treatment options.  These include bright light therapy, psychotherapy, and antidepressant medications. 

If you find yourself feeling blue and sluggish this winter but don’t feel it is severe enough to warrant seeing a doctor, there are some things you can do to lift your mood.

1.  Work up a sweat. Make sure you’re working out at least three to four times a week for a minimum of 30 minutes. That short amount of time has been shown to effectively relieve the symptoms of mild to moderate depression.

2. Focus on a healthy diet. Not giving into the carbohydrate craving and focusing your diet on fruits, vegetables, and lean proteins may also help to give you a boost and avoid the weight gain that is often associated with SAD. 

3. Limit caffeine, even though it sounds counterintuitive. Caffeinated sodas spike insulin levels and drop blood sugar levels, thereby contributing to a sense of fatigue, while coffee and tea can be dehydrating. If you need a lift, reach for hydrating water instead. That plus a small snack may give you a better energy boost.

4. Get Outside. Since daylight hours are fewer in the winter, try to sneak in a 15 minute walk when you can. Some vitamin D coupled with fresh air will do your mind some good.

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