Seasonal Affective Disorder more prevalent in northern climes

SHARON — Seasonal Affective Disorder, otherwise know as SAD, is an important issue, especially for those living in northern latitudes.

SAD affects approximately ten million people across the United States, an estimated prevalence of 0.5 to 3%.

In a recent interview with Dr. Sabooh Mubbashar, chief of psychiatry at Sharon Hospital, who has worked with SAD patients for several decades, he shared both general information about the disorder as well as recommendations for treatment and relief.

With SAD, as geographical latitude rises, so does prevalence. For example, New Hampshire has a rate of 9% while Florida has a 1.9% rate.

Symptoms of SAD include: sad mood, low energy or lethargy, difficulty concentrating, withdrawal from social life, excess carbohydrate and sugar consumption, and insomnia or hypersomnia.

SAD is currently identified under the umbrella of depressive disorders, however, experts are advocating that it have its own diagnostic category. A person with SAD meets criteria for this type of depression when symptoms correlate with seasons, whereas depression occurs at any time of year and may be exacerbated during the winter, but does not correlate seasonly. In SAD, there will be a full remittance of symptoms when the season is over.

According to Dr. Mubbasar, there are a number of prevalent theories about the causes of SAD.

With the Phase Shift hypothesis, experts argue that the disorder is related to exposure of light, that an invividual’s biological clock is out of phase, mostly delayed, with the day/night cycle.

Another theory is that in some inviduals the disorder may have to do with neurotransmitters and genetics — they may have a higher level of a protein called SERT, which interferes with the action of serotonin, leaving it less available in the brain. Serotonin, a neurotransmitter in the brain, regulates mood and low levels are associated with depression. People with higher levels of SERT tend to be more predisposed to SAD.

Finally, there is the Photo-Count hypothesis. With less intense daylight the body has a higher melatonin release and lower serotonin concentrations.

Dr. Mubbasar recommends a number of treatments to patients including light therapy, vitamin D supplementation, medications, and cognitive behavioral therapy.

Light therapy involves using a cool white florescent light behind an ultraviolet sheild. Light strength must be 10,000 LUX (units of illuminance based on an international standard) every day for thirty- forty five minutes. Light therapy can be done while doing every day activities such as reading a book or having a meal. Light boxes are available online for as little as forty dollars. If light therapy is the right fit, an individual will see a difference in about one to two weeks.

According to Dr. Mubbasar, the best medicine is prevention, so light therapy should be started in late September and continue through mid March.

Vitamin D therapy will be important if an individual has low levels. There is a 41.6 % vitamin D deficiency prevalency across the United States. Vitamin D is invloved in serotonin neurotransmission, a process necessary for physical and emotional wellbeing. In an individual with SAD, it is important to get regular versus annual vitamin D measurements to ensure proper dosing, Dr. Mubbasar tells us.

Cognitive behavioral therapy (CBT) in short duration can be a useful form of treatment, even in short six- eight week duration. CBT can enhance one’s repetoire by increasing motivation, developing routine and structure/schedule, identifying and planning for enjoyable activities during the winter months, and shifting negative thought process to more positive framework.

For more severe symptoms, which can include impairment in daily functioning, difficulty keeping up with work/life demands, or suicidal ideation, Dr. Mubbasar will utilize a medication for patients, usually an antidpressant.

Support groups can also be helpful. In coping with SAD, proper diagnosis and treament can be life changing.

Isabelle Clark is a licensed independent clinical social worker.