What You Should Know About SAD and Chronic Pain

Lack of sunlight isn't the only cause of seasonal affective disorder (SAD). If you live with chronic pain, SAD should be on your radar since some small studies suggest a link.

Many people aren’t fond of winter. The short days, bitter cold, and icy streets can put a damper on even the liveliest spirits. But if the cold weather finds you irritable, exhausted, distracted, and withdrawn, you may be dealing with something else—seasonal affective disorder (SAD).

SAD is a form of depression that occurs during a particular time of the year, typically the winter.1 Winter-based SAD symptoms include low energy, weight gain, and sleeping more; Shanthi Mogali, MD, Director of Psychiatry at Mountainside Treatment Center at in Canaan, Connecticut, says other common symptoms include: isolating oneself from peers and friends, self-medicating with substances, and anhedonia, “which is the inability to experience pleasure, or a lack of interest in activities and areas that you typically find enjoyable.” (Note: Summer-based SAD is characterized by restlessness, a decline in appetite, and insomnia.2)

If you’re dealing with chronic pain, SAD should be on your radar. Dr. Mogali says she sees many SAD patients who also complain of pain, and two small studies suggest that some patients with chronic fatigue syndrome3 or myofascial face pain4 may also show signs of SAD. (These symptoms may be related to low levels of vitamin D, which is associated with anxiety and depression in fibromyalgia patients.5)

Who Is at Risk?

How many people are affected? Estimates vary,6 but a recent study suggests that about 5% (or 14.5 million) Americans experience SAD every year.7 SAD is more common among young people, women, people with a history (either personal or familial) of depression or bipolar disorder, as well as those who live far from the equator.8

If you suspect you’re suffering from SAD, speak to your physician as treatment for SAD can help you feel better.

SAD Can Be Treated

Fortunately, there are several effective treatment options available:

Light Therapy (or Phototherapy): For many, this is the first-line treatment for SAD. After waking up in the morning, patients sit 12-18 inches from a light box—an illuminated device that should emit 10,000 lux of strong white light and very little ultraviolet (UV) light—for 30-45 minute sessions. A two-week course of treatment is usually effective.9 Light boxes are available without a prescription,10 and online, prices range from $40 to over $400. With a SAD diagnosis from your doctor, insurance may cover some of the cost,11 but be sure to speak to your doctor and your insurance carrier before purchasing a light box.

Medication: Antidepressants are also used to treat SAD; popular options include a class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs), particularly fluoxetine (Prozac) and bupropion (Wellbutrin).12 If you want to try antidepressants, Dr. Mogali says, “It helps to start early, because it does take about 6-8 weeks for the medication to become effective.” However, some patients find potential side effects, like digestive discomfort and sleep problem,13 difficult to tolerate.14

Cognitive Behavioral Therapy (CBT): This form of talk therapy can help treat SAD.15,16 In CBT, trained clinicians encourage patients to challenge unhelpful thought patterns17 and become more active and engaged with others, as well as plan for future SAD episodes.

Vitamin D: While there haven’t been many studies researching vitamin D’s effect on SAD, some researchers have found a link between low levels of vitamin D in the blood and depression.18,19 Vitamin D is produced by the body after exposure to the sun, and since people tend to have lower vitamin D levels in the winter,20 getting more of this nutrient (either through foods or supplements) could help alleviate SAD symptoms. Plus, there may be an added benefit: Stewart B. Leavitt, MA, PhD, writing in Practical Pain Management, thinks a vitamin D supplement may help patients cope with chronic pain. 21 Note that the tolerable upper intake level is 4,000 IU (100 mcg) a day for adults.22

Dr. Mogali also recommends exercise. “Physical fitness lends us natural endorphins [pain-relieving hormones] that can help boost moods,” she says. In fact, a lack of exercise could be one reason for a possible link between chronic pain and SAD symptoms: Physical activity is recommended for the relief of everything from lower back pain to fibromyalgia 23 to arthritis.24 But “People tend to be more sedentary during the winter, and that can lead to feelings of low self-confidence and unhappiness,” Dr. Mogali says. Furthermore, in an English study of close to 2,500 people, respondents were most likely to experience pain in the winter.25

Still, says Dr. Mogali, “You can find many ways to be active even during the winter months: follow an exercise class online or on cable television, meet a friend for indoor tennis or a yoga class, incentivize yourself by setting up—and paying for—a gym membership.” The importance of exercise can be overstated. By adding physical activity to your treatment plan, you’ll help fight chronic pain and depressive symptoms at the same time.

Updated on: 02/17/17
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