Depression is very common in seniors, with the severity of the condition strongly correlating to poor health and decreased functioning, both traits frequently seen in elderly nursing home residents. Senior Depression is also associated with cognitive decline even when dementia is not present. Depression in the elderly is particularly hard to diagnose, as many seniors are less inclined than younger adults to report their symptoms. Seniors are particularly vulnerable, however, as depression is also a side effect of many medications routinely prescribed to the elderly for other common conditions.
There are a number of different types of depression, just as there are causes and triggers. Seasonal affective disorder (SAD) is a seasonal form of clinical depression typically seen in the fall and winter. People who suffer from SAD feel fine at other times of the year. It affects an estimated six percent of the US population and two to three percent of the Canadian population. It is more common in women than men. It is not a self-diagnosable ailment.1,2
Common Symptoms & Causes of Seasonal Affective Disorder
Some of the most common signs of Seasonal Affective Disorder include:
- Extreme fatigue or sluggishness
- Lack of interest in normally pleasurable activities
- Increased appetite, carbohydrate craving, overeating and weight gain
- Suicidal thoughts (during more severe episodes).
As days grow shorter and nights longer in the fall and into the winter, our circadian rhythm, the physiological process that helps regulate the body's internal clock, may be affected. This seasonal shift can disrupt our sleep-wake cycle. In prolonged darkness, levels of the bio-hormone melatonin will increase, making us more prone to sleep and depression. Additionally, with reduced sunlight serotonin, one of our natural brain neurotransmitters is reduced. This, too, can lead to senior depression. 3-5
What can be done to treat Seasonal Affective Disorder?
Lots of people admit they've felt “down” during the shorter days of fall and winter. However, the “winter blues” or “blahs” are less severe than Seasonal Affective Disorder and are not a clinical depression. These last for a shorter time and are not associated with the hopeless, low feelings that are associated with Seasonal Affective Disorder.
The American Psychiatric Association's guidelines on major depressive disorders recommend the entire range of depressive treatments for Seasonal Affective Disorder.3 These include:
- Antidepressant therapies
- Light therapy (Note: Light therapy is considered to be an adjunct to antidepressant therapies for severe forms of SAD.3)
Can antidepressants be used to treat Seasonal Affective Disorder?
Antidepressant therapy with dopamine reuptake inhibitors, serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors are effective for treating SAD just as they are for generalized senior depression. These drugs increase brain concentrations of these neurotransmitters. Some of these agents are listed in Table 1.5
|Trade Name||Generic Name|
|Wellbutrin SR or Wellbutrin XL*||Bupropion sustained release or extended-release|
|* FDA approved for SAD|
These agents require one to two month for effectiveness in relieving senior depression and would need to be taken prior to decreased light seasons. So you'd need to begin taking one of these antidepressants in early October or well before low light days begin in your area. Additionally, once the low light season is over, tampering off of these antidepressants is important to prevent withdrawal symptoms such as flu-like feelings, insomnia, imbalance, sensory disturbances and hyperarousal. Prozac is perhaps the only antidepressant which may not need to be tapered because it is cleared from the body slowly.
Is light therapy an effective treatment for Seasonal Affective Disorder?
As an adjunct and in some instances an alternative to antidepressant therapy, light therapy may be effective for treating SAD. Effective light therapy is achieved by exposure to 10,000 lux cool-white light at a fixed distance. Lower intensity-rated products are available but require closer distances and extended exposure. Optimal exposure is for thirty to forty-five minutes early in the morning upon awakening. Eyes must be open, not closed, for therapy to be effective. Boxes are supplied with either full-spectrum or broad spectrum lights. Full spectrum lights include the ultraviolet spectrum. They should be supplied with an ultraviolet filter or diffuser for safety. Broad spectrum lights exclude the ultraviolet spectrum.4
The Circadian Lighting Association, an international trade association of light therapy manufacturers, sets product standards for manufacturers and performs independent product quality checks.6 You can access their Web site for product-related information. Some manufacturers listed on the association's Web site are shown in Table 2.6
Stay active in both mind and body… take care!
Dr. Joe Woelfel
- Rosenthal, NE. Winter blues: seasonal affective disorder: what it is and how to overcome it. The Guilford Press, New York, NY 2002. pp. 3-4.
- Lam RW, Levitt AJ. Canadian consensus guidelines for the treatment of seasonal affective disorder. Clinical & Academic Publishing, Vancouver BC 1999.
- Anon. Practice guideline for the treatment of patients with major depressive disorder. Second Edition. American Psychiatric Association April 2000 http://www.psych.org/psych_pract/treatg/pg/Practice%20Guidelines8904/MajorDepressiveDisorder_2e.pdf. (Accessed online January 20, 2009).
- Lam RW. Seasonal affective disorder: diagnosis and management. Primary Care Psych 1998;4:63-74.
- Seasonal affective disorder, Mayo Clinic, 2008 http://www.mayoclinic.com/health/seasonal-affective-disorder/DS00195/DSECTION=causes (Accessed online January 14, 2009).
- Anon. Choosing the right bright light product. Circadian Lighting Association. http://www.claorg.org. (Accessed online January 21, 2009).