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Seasonal affective disorder a downside of winter

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The winter that keeps pounding away has made getting up in the morning a hurdle for Watertown resident Tracy K. Abihai, who says the lack of sunlight has taken a toll on her mood.

“It’s tiring,” said the 39-year-old native of Hawaii. “I really don’t want to wake up in the morning if I see the snow. If I don’t have to work, I don’t go anywhere because I feel sad. If I’m not working, I have to figure out what I’m doing with my day.”

Dr. Fahd Rawra, a psychiatrist at Samaritan Medical Center, Watertown, hasn’t treated Ms. Abihai, but said she might be experiencing seasonal affective disorder, or SAD, a type of depression.

Research by Dr. Norman E. Rosenthal, the clinical psychiatrist who first described the condition in the mid-1980s, shows SAD is influenced by latitude, affecting about 1.5 percent of the population in Florida and 9 percent in New Hampshire. New York state is not included in the research. Meanwhile, 4 to 6 percent of the U.S. population might have winter depression, according to the Cleveland Clinic’s website.

Dr. Rosenthal, on his website, defines seasonal affective disorder as “a type of depression that occurs regularly, every autumn and winter, when the days get short and dark, though it may occur at other times as well.”

Though it’s normal for people to feel “down” during the winter and eager for spring to begin, professional treatment should be sought if symptoms of sadness and hopelessness persist day after day without relief, Dr. Rawra said. Other symptoms of SAD, also called seasonal depression, might include fatigue, strained relationships with colleagues and friends, and an unusually strong appetite that can lead to excessive weight gain.

“It’s one thing if I’m feeling sad today, and the next day I’m fine,” Dr. Rawra said. “But if I wake up and I’ve been down in the dumps for days, then there is a concern. This condition has severe symptoms that are lasting throughout the day, day in and day out, that affect your ability to function. You don’t enjoy the things that you used to.”

Dr. Rawra said three main therapies are used to treat SAD: mental health counseling, light exposure therapy and antidepressants for serious cases. He said exposure to more light, especially during the morning, may significantly improve symptoms of SAD. Special light boxes, which include a full spectrum of light to emulate sunlight, are effective in some cases, he said.

Kristin W. Brown, a licensed clinical social worker at St. Lawrence County Mental Health Clinic in Canton, recommends that patients with symptoms of SAD make lifestyle changes to expose themselves to sunlight. Breaking up the winter months by taking vacations to warmer climates might help.

Mrs. Brown said her group encourages exercise, healthy eating and getting fresh air.

“I recently heard from a patient from Potsdam who went with her family to Florida for a week over winter break,” Mrs. Brown said. “They spent a lot of time in the sun and were able to get a lot of fresh air and sunlight, and they were saying their overall mood was better.”

Travel Galore, a travel agency in Sackets Harbor, has booked trips in the past few weeks for couples who have become jaded with the north country winter, owner Louine M. Kolb said.

“I have a couple of people who have booked flights and mentioned they’ve had to get out of here,” Mrs. Kolb said. “One is a Watertown couple that flew to Key Largo, and the other couple, from Sackets Harbor, is on a cruise in Fort Lauderdale. Usually people book trips three months out, but these people just booked a few weeks ago.”

The winter doldrums are one thing, but seasonal affective disorder is another.

Shorter daylight hours in colder climates, such as Northern New York, may contribute to SAD, Dr. Rawra said. Research has linked the condition to a biochemical imbalance in the brain caused by less daylight during the fall and winter, he said. When seasons change in the fall, people may experience a shift in their circadian rhythm, or biological internal clock, making them feel out of sync with their daily schedules.

The sleep-related hormone melatonin, which has been associated with SAD, might also play a role, Dr. Rawra said. The hormone is secreted during the evening, sending a signal to the body that it’s dark outside.

“Sunlight suppresses melatonin, but the absence of sunlight can increase levels in the brain,” he said.

Frigid, dreary days have come in near relentless succession in the north country this winter, and snowfall has been heavy, with 170 inches in Watertown, compared with 72 at this point last winter and 41 the previous year, according to data collected at the Watertown Filtration Plant. The average snowfall is 88 inches from December through February.

“Winters in 2011 and 2012 were very mild, so this year seems really cold and snowy because the last two years haven’t been so bad,” said Jessica L. Spaccio, a climatologist at the Northeast Regional Climate Center at Cornell University, Ithaca.

The average high temperature at Watertown International Airport this winter has been 29, and the average low has been 10, according to the center. Both numbers are about three degrees below normal.

In emulating sunlight, special light boxes can help people with seasonal affective disorder, Dr. Rawra said.

“You turn it on in your room in the morning when you get up and keep it on for a couple of hours,” he said. “Sometimes within a couple of hours people can notice a difference.”

For more severe cases of SAD, antidepressants called selective serotonin reuptake inhibitors, or SSRIs, might help increase levels of serotonin in the brain to improve symptoms.

“If a person is having difficulty functioning, we may take that line of treatment,” Dr. Rawra said. “If it gets severe enough, a person could have thoughts about hurting themselves or even not wanting to live.”

But those are extreme cases. According to the Cleveland Clinic’s website, an estimated 20 to 30 percent of the population living in the “middle to northern latitudes” of the United States might experience some SAD symptoms.

Ms. Abihai, who works at the Dunkin’ Donuts on Arsenal Street, said she walks to work from her apartment when the snow on sidewalks is manageable, but that has been rare this winter. Ms. Abihai recalled feeling down when the ice storm in late December left her home without power for days. But on Feb. 22, she was excited to show her coworkers pictures of uncovered grass taken on her smartphone.

“I like to walk outside everywhere but can’t do it with all of this snow,” she said, adding that the increased sunlight in recent weeks has lifted her mood.

Ms. Abihai, who moved to the north country from Hawaii with her family when she was 18, said she hopes the worst of the winter weather is over.

“I’m crossing my fingers and looking for grass every day,” she said. “I don’t want any more snow.”

SAD REMEDIES
Tips for reducing symptoms of seasonal affective disorder, or SAD:
• Sleep well: make sure you wake up at the same time every day, including on weekends. Doing so will keep your body’s internal clock in sync.
nLet the light in: expose yourself to as much sunlight as possible by opening your blinds at home and making sure your work space has natural or bright light.
nControl your cravings: eat a balanced diet while limiting the amount of carbohydrates you consume. Carbs can provide a short-term energy boost but leave you feeling worse later in the day.
nEmbrace an exercise routine: exercise not only is good for your physical health, it also helps relieve the stress and anxiety that can increase the symptoms of SAD. Doing yoga and Pilates are among the ways to relax and exercise at the same time.
nManage your stress: take time to relax and manage your stress each day so that it doesn’t lead to depression and overeating. Stay connected to people who are important to you, because they’ll help you remain calm and happy.
Source: Northwestern Memorial Hospital, Chicago
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