Multiple Sclerosis and the Winter Blues

September 05, 2014
Many people with Multiple Sclerosis look forward to the cooler temperatures and reduced humidity that comes with fall and winter. Symptoms can be worse in the warm summer months so relief comes to many with the lower temperatures. With fall and winter right around the corner, it’s important to be aware of and prepare for the Winter Blues. 
 
The Winter Blues is fairly common in northern latitudes where the days become shorter and there is reduced sunlight.  The Winter Blues is often characterized by feeling irritable or gloomy, having less energy, sleeping more but not feeling more rested, and eating more, often with cravings for carbohydrates.  So what can one do to prevent the Winter Blues? 
 
  • Exercise: Exercise can help improve mood, energy, and sleep, all of which can be affected by the Winter Blues.  It can also help motivate you to make better food choices.
  • Eat a Balanced and Healthy Diet: Make good food choices.  Avoid loading up on “comfort” foods and carbohydrates.  Many people find that they eat healthier during the summer months but revert back to “old eating habits” during the winter months.
  • Exposure to Light: Open up the curtains and blinds in your home and office and sit by the windows whenever possible.  Get out of the house and into the ambient light even if it’s gray and cloudy outside.  You are still getting exposure to light.
  • Avoid Binge Drinking: Alcohol is a central nervous system depressant, so drinking too much on a regular basis can actually contribute to feeling “blue” and “down.” 
  • Stay Connected with Others: During the winter months it is tempting to “hibernate” at home and not get out as much.  Neighbors often don’t see each other or talk to each other as winter sets in.  So it’s important to make an effort to stay connected to others.
 
The good news about the Winter Blues is that it clears up on its own in a relatively short period of time.  And as the seasons change and the days grow longer, we can all say goodbye to the Winter Blues.
 
But what if the Winter Blues becomes more severe?  And lasts a lot longer?  And comes back year after year?  If this is the case, it may be that one is suffering from Seasonal Affective Disorder (SAD).  SAD is a medical condition, first described by Dr. Norman E. Rosenthal and colleagues at the National Institutes of Health in 1984.  SAD is a type of depression that is triggered by the changing seasons.  It typically occurs during the fall and winter months when there is less ambient light.  A much less common type of SAD appears during the spring and summer months.  People who suffer from SAD tend to become depressed during the same time of year, year after year.  People with SAD may feel depressed, anxious, hopeless, feel “heavy”, have low energy, sleep more, withdraw from others, eat more or less, no longer enjoy activities that are important to them, and have difficulty concentrating.  And these symptoms can persist for months until the season changes. 
 
The specific cause of SAD is not known but it is thought that lower levels of sunlight may disrupt the body’s internal clock (circadian rhythm).  During the day your brain sends signals to others parts of the body to help keep you awake and active.  At night the pineal gland in the brain produces a chemical, melatonin, which helps you sleep.  Shortened daylight hours can alter this system and may be what leads to SAD in some people.  Reduced sunlight can also case a drop in serotonin, a chemical in the brain that affects mood.
 
Between 4% and 6% of people in the United States suffer from SAD.  Another 10% to 20% may experience a mild form of SAD.  It is four times more common in women than men, more common in people who live farther from the equator, and the risk of developing SAD decreases as one gets older. 
 
The good news is that there are effective treatments for SAD.  Effective treatments include Light Therapy, Cognitive Therapy, and Medications. 
 
  • Light Therapy: Up to 70% of people with SAD experience improvement in symptoms with Light Therapy.  There are two common types of Light Therapy.  Bright Light Therapy involves sitting in front of a bright light box (a box that artificially stimulates high intensity sunlight without exposure to harmful UV rays) for 30 minutes daily, preferably in the morning hours.  Tanning beds are not a substitute for Light Therapy as they are high in harmful UV rays.  Dawn Stimulation Therapy involves a dim light going off in the early morning hours before one is awake and gradually getting brighter, mimicking the sunrise.  The benefits of Light Therapy can be seen within several days and there are few side effects to this treatment.
  • Cognitive Therapy: There is growing evidence that Cognitive Therapy, a form of talk therapy, is helpful in treating SAD.  The use of Cognitive Therapy has the added benefit of reducing the yearly occurrence.
  • Medications: The antidepressant bupropion (Wellbutrin) has been approved by the FDA for the treatment of SAD.  There are other antidepressants that may be effective in treating SAD as well.
 
So if you feel blue this winter, and the feeling lasts for more than a few weeks, talk to your health care provider.  You may be suffering from SAD.