Rock the SAD Away

28 11 2010

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Apologies for the long hiatus since the last post: I believe I have been suffering from SAD (seasonal affective disorder), which is the onset of symptoms of depression (e.g., overeating of carbs, oversleeping, general lack of motivation to do anything) during the winter months (although it is also possible for SAD to manifest as spring-summer depression rather than autumn-winter depression).  Some have designated SAD as a leftover adaptive trait akin to hibernation while others have postulated about vitamin D deficiency and/or melatonin hypersecretion during the winter months as a risk factor of SAD (due to low levels of sunlight).  I think November is a bad month for me because the days are shorter than in almost any other month, the sky is darker, and the oversleeping means that I miss most of what little daylight there is.  The overeating and the lack of motivation to go to the gym or dress nicely means that my self-confidence has also taken quite a hit, which just feeds right into the delightful cycle of overeating, oversleeping, anhedonia, and unproductivity.

Of course, it doesn’t help that artificial lighting has been linked to overeating and obesity, because the decrease in natural light during November means the increase in artificial lighting.

But my point of this post is two-fold.  First, it was to explain and apologize for my lack of updating this site (but I’m getting better so expect more ramblings asap!).  But second and more importantly, it’s to point out that SAD can affect anyone, especially students who are already stressed at this time of year as it is (because of exams, assignments, papers, and balancing school, life, family, extracurriculars, and everything else during the holiday season).  SAD has been found to affect somewhere between 1% to 10% of North American populations.  So if you are like me, and you have been feeling particularly unproductive (I’ve pretty much just stayed at home watching old episodes of “The Nanny” while ignoring most academic, social, and personal responsibilities), it’s sometimes helpful just to know that there’s a reason for it that’s not your fault.  It’s good to know that I’m not just getting fat and lazy because something has changed in my personality and in my ambitions, but because I’m suffering from an illness.

And if you are suffering from SAD, November is almost over, so hopefully it’ll get better once the holidays arrive and the Winter Solstice has passed (meaning that the days will become longer).  But if you are strongly affected by SAD (or even if you just want it to go away), there are things you can do to fight it.

For me, what has worked is forcing myself to sleep earlier and wake up when there is sunlight.  Maximizing sunlight exposure makes a world of difference; regardless of whether it’s the placebo effect, vitamin D production, the sociocultural effect of being with my community during the daytime, or some other effect altogether.  What has also worked for me is making the effort to exercise, dress up, and be with people I care about, because doing things that make me happy and give me confidence will hopefully feed into a positive cycle of feeling less depressed and more energetic.  I’ve also been experimenting with turning on the heat in my apartment, because I realize that part of the reason I overeat and feel lethargic may be due to the fact a lot of my resting metabolic energy is dedicated to producing heat to keep my body and brain warm, which diverts attention away from other matters, like thinking and studying (good excuse, eh? =D).

If those tricks don’t work for you, you can try taking vitamin D supplements, using light therapy (bright light, or perhaps green light, which may suppress melatonin production – I’m buying a light box as I type!), dawn simulation (having lights gradually turn on just before the alarm rings to wake you up), and high-density negative ionization (releasing charged particles into the sleep environment – my light box also emits negative ions!), although I would suggest going into the primary literature to look at clinical trials to learn more about how effective these treatments are and whether they are likely to work for your demographic.

If these therapies still don’t work, you can visit a psychiatrist, who can then help with diagnosis and treatment, and may prescribe antidepressants, timed melatonin doses, cognitive behavioural therapy, or other treatments, depending on what is right for you.

I think the unknown is the scariest thing.  Knowing what we’re dealing with is half the battle.  And now, I can try to treat myself for a psychiatric condition (although it’s not really a stand-alone condition in the DSM-IV, and I don’t know that I would actually qualify as suffering from it according to the DSM…).

Hopefully with the onset of snow, the white, bright, cleanliness of it all will help me fight this SADness.

On a related note, I have decided to start petitioning for clocks not to be put back during the fall, for the sake of health!

November is almost over…

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2 responses

29 11 2010
Eastwood

I purchased a Litebook in the summer of 2009 in an attempt to reset my circadian rhythm. Because I took night classes and the sun stayed up until evening during those summer months, I got into the regular habit of going to bed at 4 AM and sleeping until noon.

I still use it every now and then, but there’s one major problem: it’s not very practical to sit in front the light for half an hour every morning. Take attending an 8 AM class, for example: it almost seems like a trade-off between losing some sleep and waking up at 5:45 to use the light, or sleeping in until 6:15 without it. So far, I’ve chosen the latter. Come to think of it, perhaps it might be a better idea to simply wake up 30 minutes earlier and bask in the light while taking care of email, etc.

Also… I suspect that the rain, particularly the kind we get in Vancouver, compounds the SADness.

Speaking of blogging, check this out when you get a second (it’s a 30-minute long CBC podcast): http://podcast.cbc.ca/mp3/whitecoat_20091128_23675.mp3 — it’s very admirable of you to write about your personal journey in the art in such an open manner. Many medical bloggers (e.g., Old MD Girl) prefer to share their stories anonymously. As a doctor in training, what’s your personal philosophy when it comes to writing about your experiences and encounters? In light of patient confidentiality and the ever-expanding reach of the internet (e.g., Google search, RateMDs.com), how do you balance the fine line? Thanks.

29 11 2010
June

Thank you for your comments, Eastwood – I always add to my Google Reader and learn about new resources from you! I really appreciate it =).

I’m listening to the podcast right now, and I think your question is quite a complicated one to answer. For me, I never thought about being anonymous, just because I think it limits me in what I can write. I think my constant need to be careful about hiding my identity would mean that my posts would lose substance. I don’t think I could be as authentic, either.

Having said that, I try to be very careful about what I do post. Regarding patient confidentiality, so far I’ve tried to stay away from talking about patients (partly because we haven’t had many instances of patient contact, but also because I’m conscious of this potential blogging problem). I think my focus has been and will hopefully continue to mostly be on the impact that any patient makes on me, rather than the details of the patient. If the details of the case are relevant, I will try to wait until some time has elapsed and I will try to change all potential identifiers, minimizing what I need to post about the patients to make my point. For now, I think I am trying to focus my writing on my life as I go through med school and everything else, rather than focusing too much on the details of any patient’s life.

Regarding the issue about future patients being able to Google my blog and read the details of my life, for now, I can only imagine what that will be like. Sometimes I think that I am naive to think that if I’m genuine and honest about my thoughts and opinions, being careful to admit my flaws and allow for dialogue, it’s good enough.

As I continue blogging and continue my journey through life, I’m sure my thoughts surrounding these issues will change and be clarified. Until then, these are my thoughts =).

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