The Winter Blues    Excerpts from Winter Blues    SAD ? - Test Yourself      Buy this Book

Excerpts from Winter Blues
by Dr. Norman E. Rosenthal

		"This is the book I recommend to all who struggle beneath the weight of winterÖ. Dr. Rosenthal is an unsurpassed expert in the field and he lays out exactly what you need to do to feel more like your 'summer self.'"
		-Michael J. Norden, MD, author of Beyond Prozac
		"This is a 'must read' for all who suffer from seasonal affective disorder - and for their parents, spouses, and significant othersÖ.This is painless medicine indeed!"
		-Dean Hamer, PhD, coauthor of Living with Our Genes
		"Read and heed Dr. Rosenthal's advice. It can change your life."
		-Jean Carper, syndicated columnist and author of Food - Your Miracle Medicine

Excerpt from Chapter 1 - Introduction: Discovering SAD

When the dark days of winter approach, do you feel slowed down and have difficulty waking up in the morning? Are you tempted to snack more on those holiday foods and find the pounds begin to creep on even as you valiantly try to diet? Maybe you find it hard to focus at work or in your relationships, feel down in the dumps or, worse still, really depressed? If you answered yes to one or more of these questions, you may be one of the millions of people who have problems with the changing seasons. One of the astonishing facts to emerge from recent research is that most people in the northern United States and Europe experience seasonal changes in mood and behavior, also known as seasonality.

In its most marked form, affecting an estimated 6 percent of the U.S. population, seasonality can actually cause a great deal of distress and difficulties in functioning both at work and in one's personal life. These estimated ten million Americans are said to be suffering from seasonal affective disorder or SAD, a condition now widely accepted by the medical community and the public at large. Another 14 percent of the adult U.S. population is estimated to suffer from a lesser form of SAD, known as the winter blues. Though these people are not usually affected severely enough to seek medical attention, they nevertheless feel less cheerful, energetic, creative, and productive during the dark winter days than at other times of the year. For the last twenty years, I have studied the seasons and their effects on myself and others. I have loved them and hated them. I have helped others struggle with and master them, even as I have often struggled with them myself. This book is written for all of you who are intrigued by the changing seasons and their effects on our minds and bodies, whether this interest derives from medical necessity, a wish to understand or help a loved one, or plain and simple curiosity. Like the bears, squirrels, and birds, humans have evolved under the sun. We incorporated into the machinery of our bodies the rhythms of night and day, of darkness and light, of cold and warmth, of scarcity and plenty. Over hundreds of thousands of years, the architecture of our bodies has been shaped by the seasons and we have developed mechanisms to deal with the regular changes that they bring. Sometimes, however, these mechanisms break down and cause us trouble.

The effects of the seasons on humans have been well known through the centuries to artists, poets, and songwriters. Shakespeare, for example, observed that "a sad tale's best for winter," while Keats wrote of a nightingale singing of summer "in full-throated ease," and the singer of a modern ballad calls his beloved the sunshine of his life. They have also been part of our ordinary language and culture. A person might be said to have a warm and sunny disposition or a dark and icy nature. The weather reports that are part of every television news program may be as much a way of helping viewers gear their mind-set accordingly as advising them on how to dress or whether to wear a raincoat.

In recent years, science and medical practice have caught up with language, culture, and the arts, and the medical importance of the seasons is now generally accepted. Signs of this are everywhere in evidence. For example, on January or February evenings, after the Christmas lights have been removed, a blue-white light can be seen streaming through the blinds and shutters of some of the homes in neighborhoods throughout the North, penetrating the inky darkness of the winter night. The fanciful might mistake this strange illumination, brighter than the incandescence of an ordinary electric light and of a different hue, for an alien spaceship landed in suburbia to understand our strange human ways or conquer our planet. The real explanation is more mundane. Thousands of people across the country are sitting in front of light boxes, specially made fixtures that emit far more light than is ordinarily available indoors, to treat their symptoms of seasonal affective disorder (SAD) or its milder variant, the winter blues. Such boxes are springing up in offices as well, as many people, unabashed by their hibernating status, are treating their symptoms while at work.

But it is not only those who suffer badly as a result of the changing seasons who are becoming more cognizant of the importance of light. Having an office with a window has taken on a new importance as workers, who always wanted a view, now realize that there are medical and psychological benefits as well to having access to natural light. The "energy-efficient" buildings with tinted-glass windows, constructed in earlier decades, are now regarded with displeasure by many of the workers who have to labor in the unnatural glow of the light transmitted through the yellow panes. In fact, in one government building near Washington, the workers mutinied and pulled the tinted "weather stripping" off the outside of the windows to let in the sunlight unimpeded.

In this book, I will describe in detail how light can be used therapeutically as well as the many other ways of treating SAD or the winter blues. I must emphasize, though, that depression can be a serious illness: painful, debilitating, and, in some cases, even fatal. While identifying depression and taking steps to combat it are an invaluable first step, if this step does not take care of the problem, a professional should be consulted sooner rather than later. There are so many things that can be done to alleviate depression, and a skillful practitioner can be an invaluable and sometimes critical ally in helping to implement these strategies. Along with specific suggestions for ways to recognize SAD or the winter blues and help oneself with these problems, I also direct the reader to various resources for additional help.

An enormous amount of research into the effects of the seasons and of light on human beings has been conducted over the last few decades. Much of this research has been based on what we know about the dramatic seasonal changes that occur in animals. I will describe some of these exciting new advances, which explain why some people experience seasonal changes so much more profoundly than others. I will also discuss the research conducted to explain how light therapy and other treatments may exert their dramatic therapeutic effects.

But it would be a shame if the seasons were considered merely as a source of suffering and distress. Aside from their capacity to induce symptoms, the seasons are of interest in their own right. The predictable changes that come with the shortening and lengthening of the days, the marked shifts in weather, and the rhythmic alternation between the barren landscape of winter and the vivid colors of summer are a continuing source of fascination.

There are indeed seasons of the mind, though they are not the same for everyone. Autumn may enchant some with its grand colors, but for others it carries the threat of winter. Winter, cheerless and forbidding for many, has associations with stagnation, decay, and loss. But some people experience a different type of winter-one that finds them snug and cozy by the fireside, with chestnuts popping. Spring brings buds and blossoms, rebirth, with sap stirring, feverish urges, and a longing to go on pilgrimages. But we are also told that "April is the cruelest month, mixing memory and desire." Summer yields a harvest of fruit and flowers, but in the words of the Bard, "sometimes too hot the eye of heaven shines."

In Part 3, "Celebrating the Seasons," I discuss how the seasons can be a rich source of inspiration and how some of our most creative writers and artists have been intensely seasonal and have included their seasonal responses in their art.

In the final chapter, "Winter Light," I discuss life beyond SAD. By now, there are many who have suffered from winter difficulties in the past, but who have successfully treated themselves for years and have largely overcome the problem. I count myself among those lucky enough to be living after the recognition of SAD and the discovery of light therapy and other strategies for overcoming the problem. Many people with SAD enjoyed the winters of their childhood before their symptoms first appeared. Then they suffered for years until they understood the nature of their problem and found successful treatments for it. After their SAD symptoms had been treated for several years, they began to rediscover the quiet pleasures of winter and to feel reconnected with their childhood. I relay some of their stories-and my own-and celebrate the joy of winter that has eluded so many of us for so long.

Excerpt from Chapter 3 - How Seasonal Are You?

Most people are seasonal, though some are more so than others. In fact, my colleagues and I at the National Institute of Mental Health (NIMH) were astonished to find that over 90 percent of all those who responded to a survey we conducted in Maryland, about thirty-nine degrees north, reported that they felt some difference in mood, energy, or behavior with the change of seasons. In this chapter, I will show you how to determine how seasonal you are by means of the Seasonal Pattern Assessment Questionnaire (SPAQ), which we developed for research purposes but turns out to be very easy to administer and interpret once you have the key. The SPAQ has now been used to establish that seasonality is actually a genetically transmitted trait, as well as to estimate the prevalence of SAD and the winter blues in many parts of the world. I will detail the results of these research findings elsewhere in the book.

To understand the pattern and extent of your seasonality, complete the SPAQ, shown in Figure 1 (page 38). To obtain a stable and accurate assessment, you will have to think back over a period of time-say, three years-when you have lived continuously in one climatic region. Since seasonality can change over time, and the most recent years are generally clearest in one's memory, think of the most recent three years during which you have lived consistently in one area when considering the questions posed by the SPAQ.

How to Interpret Your Scores on the SPAQ

What is your seasonal pattern?

The first step in determining how seasonal you are is to rate your seasonal pattern. Based on the analysis of many SPAQ responses, we came up with definitions for different patterns of seasonality. How you filled out the questionnaire will give you an idea of which one applies to you:

If you feel worst in December, January, or February, you have a winter seasonal pattern. Almost half of all people in the northern United States report that they feel worst during the winter and can be said to have a winter pattern of seasonality. This pattern is more marked among people who live at higher latitudes. For example, a higher percentage of people dislike winter in New Hampshire (forty-two degrees north) than in Sarasota, Florida (twenty-seven degrees north). On the other hand, the closer one is to the equator, the more people say they dislike summer. By the time one reaches Sarasota, Florida, more people report disliking the summer than the winter, presumably because of the heat and humidity.

Most winter types report eating most, sleeping most, and gaining the most weight in the winter months and, conversely, eating and sleeping least and losing weight during the summer months. They also find it easiest to socialize during the summer. Although they often join in the round of parties that takes place at Christmas, they find it hard to muster up the spontaneous pleasure of summer get-togethers, where they feel a true desire to mix with people. Rather, winter celebrations often take on the quality of a chore, a command performance, asked of people who would much rather be left alone with a dish of sweets. Indeed, people with SAD often report a strong preference for sweets and starches during the winter months-an exaggeration of an eating trend observed in the general population. People also commonly report preferring "heavy" foods-stews and casseroles-during the winter months, whereas salads, fresh fruit and vegetables, and protein-rich foods are preferred in the summer months.

If you feel worst in July or August, you have a summer seasonal pattern. Interestingly, winter types are far more common in the United States and Europe, while in Japan and China, more people dislike the summer. At this time, it is unclear whether these differences are genetic or related to the more widespread availability of air conditioning in warm regions in the West. People who dislike summer may tend to socialize least at that time. Unlike winter types, they often do not overeat, oversleep, and gain weight during the time of year when they feel the worst. Instead, they tend to eat less, lose weight, and sleep less.

As more people learn to control their winter symptoms by modifying their environmental light, and as the world's climate heats up as a result of the greenhouse effect, I would predict that the percentage of those who dislike summer will increase and the percentage of those who dislike winter will decrease.

If you feel worst during December, January, or February and July or August, you have a summer-winter pattern. Summer-winter types may enjoy only the spring and fall.

If there is no time of year when you generally feel best or worst, you have a nonseasonal pattern. Some people report very few seasonal changes at all. These people will generally mark most of the items in question 2 as not changing with the seasons.

There are other, less common seasonal patterns. For example, some people feel worst in the spring; others in spring and fall. Note that the patterns discussed here refer to those who have been living in the northern hemisphere; the opposite months would apply to those in the southern hemisphere.

The pattern of sleeping and eating more and gaining weight in the winter is seen in the general population as well as SAD patients. What distinguishes people with SAD and the winter blues from the general population is the overall seasonality score, which is greater in the first two groups than in the population at large.

  Buy this Book