Dr. Kevin Most: Time change and SAD
Well, we are one month into our time change as the clocks fell back the first weekend in November. Are there any health issues that arise from this change? I think there are a couple, one is somewhat preventative, the other one in some people can be treated and perhaps prevented.
The first thing I recommend at this time is to check and make sure your furnace has been cleaned, your filters have been changed and your smoke and carbon monoxide detectors have new batteries. This time of the year as we fire up our heaters we need to understand the health risk associated with heaters. Carbon Monoxide poisioning is the most dangerous, it can be a silent killer so the need for the detectors cannot be minimized. Each year we hear about a family who dies in their sleep as the home fills with the odorless carbon monoxide. Please take a minute to change your batteries and have the furnace serviced.
Back to the time change issue. Does this change impact us? Is the extra 1 hour in either direction really a big deal? Has anyone looked at the impact of Daylight Savings Time on our health? It has been around for 100 years, does it save energy? Save money? Help farmers? These were all the reasons for the change, some would argue we should stay with Daylight savings time year round as our current Standard time impacts how much time in our regular day allows for sun exposure.
We always complain in the spring, when we “lose an hour”, but the health impact of the time change in the fall, when we get an extra hour sleep can last for months.
One of the biggest health issues we see this time of the year associated with the time change, is a condition called Seasonal Affective Disorder (SAD). Many equate this only with the winter but in fact we see SAD in the summer as well for some people. The Winter SAD is much more prevalent. Many think of this as the “winter blues”. It is a common disorder that actually impacts up to 20% of the population and has a higher incident as you move further north. For those afflicted with Winter SAD the symptoms often begin mild but will worsen as the season progresses. Without treatment or intervention the symptoms may persist thru the early spring. Many individuals will have SAD and really not even notice it for a while.
As we share the symptoms, many of you will be saying , “yes, I have that, Yes, I have that” this is why the spectrum of this disease is wide and often under reported.
1.) Having low energy
2.) Weight gain
3.) Tiredness or low energy
5.) Appetite changes, craving high carb foods
6.) Feeling sluggish
7.) Difficulty concentrating
8.) Losing interest in activities
9.) Feeling depressed for extended times each day
When you look at these, you may be thinking they are just inconveniences from living in the north, but SAD can have complications that impact our lives and those around us. Common complications include increase in substance abuse, commonly alcohol. It can cause work or school problems due to poor concentration and sluggish feeling. It certainly has been shown to cause an increase in social withdrawal which many equate to cold weather but is actually more mental in its cause.
So like many of our discussions we discuss the cause in the hopes that we can prevent the problem. There is no exact proven cause for SAD however there are many factors that are thought to impact us and the treatment options are built on these assumptions.
· Thru the summer our internal body biological clock is changed in 2 ways, one is just the days becoming shorter with sunlight and the second is the change in the clocks which can act as a shock.
· We know that serotonin a chemical in the brain that impacts our mood and pleasure is lower in the winter. The reduced sunlight causes a drop in serotonin
· Melatonin is a chemical that is also impacted by daylight and it plays a big role in our mood as well as sleep patterns.
· Risk factors include, already having a diagnosis of depression or bipolar, and SAD can make the depression worse.
· Living further away from the equator shows an increase incident and risk of SAD, thought to be due to the decrease in sunlight.
So how do we diagnose individuals with SAD? The biggest concern we have is to not miss another more serious psychological disorder or other physical disorder that may cause similar symptoms. Low thyroid, or anemia can cause many of the symptoms and treatment is obviously different. Your physician will take a history on the symptoms you are sharing and look for a seasonal pattern, they may do blood tests to look for other causes. There is a checklist that the physician will use to make the diagnosis. Depending on the onset some of the expected changes may not have occurred and may be prevented with treatment and education.
The one treatment we all consider at this time of the year is to move closer to the equator. We know the incidence of SAD increases as we head north for the reasons we discussed earlier, so one would imagine that the symptoms and incidence would decrease as we move south. Warmer climate equates to more time spent outdoors which impacts the chemicals in your brain that impact mood. The bad thing is we all can’t just pick up and move for 6 months, so we need other options.
The easiest one actually also makes the most sense, if a decrease in sunlight causes the problems, then an increase in light should help the problem. Light Therapy or phototherapy is the most common treatment and thought to be much better than using medications. For this you need a specific light source called a light box. It is not good enough to just turn on the lights. The light box should provide 10,000 lux of light and emit as little UV light as possible. Discussing the choice with your doctor may be a good idea.
Light boxes are not approved or regulated by the FDA, so choosing the right one is key. It should be made specifically for SAD, you should look for one that emits 10,000 lux of light but also a low level of UV light. The low UV light is important to protect your eyes. The lights come in many different shapes and styles so try to figure out where you would use it each morning. It may be while reading the paper, having coffee or however it can fit in your daily activity. The treatment is pretty specific as the therapy should be started within an hour of waking and also the light should be within 2 feet of your face
One thing to really highlight is that a tanning bed cannot and should not be substituted for the possibility of benefits to treat SAD. This has not been shown to be true and the use of tanning beds increases your chance of melanoma by 60% and the risk increases with each use. So the thought that the tan from the tanning bed will help with SAD is wrong as well as the thought that having a tan during the winter is good. Stay away from the tanning beds.
Some physicians may recommend medications, especially if your life style does not allow for the use of the phototherapy, or if your symptoms are more severe. Antidepressant medications do not work like antibiotics and in most cases will need to be taken for 3-4 weeks before changes are noted. For this reason, individuals who have a history of SAD will often be told to take their medications in early September before any symptoms are noted and prior to the time change.
There are many things one can do to help this without taking medications. Simple things like opening the blinds to the house during the day, in the winter blinds are often closed for heat conservation or privacy. Get out for a walk when it is light out, even if it is cold, the light and exercise help dramatically. Find time to exercise, at a health club or at home. This is good for your physical as well as mental health. Many will find that yoga, music therapy can help as well.