Feeling S.A.D.

There is a crack in everything

that’s how the light gets in.

Leonard Cohen

As I shared in last week’s post, I grew up in western Washington, known for its abundant rainfall. It turns out that is not quite true. Seattle receives less rain than any city on the east coast.* This may be hard to believe for people who have visited in the winter time or attended the city’s annual Bumbershoot Festival.

What Seattle and the rest of western Washington do have are lots of gray skies. Typically by mid-September a light drizzle starts to fall; the sun is clouded over, and often will not make its next appearance until mid-May in a good year. I remember occasional summers when the clouds persisted all summer long with only brief sun breaks. Fortunately that was rare, but even in good summers, light rain and clouds can be expected every week or two, at least until recently now that the west coast, like the rest of the world, is experiencing warmer temperatures and even droughts.

As a hiker I learned to always prepare for rain, carrying a dependable rain suit and pack cover for the inevitable rain showers that would fall at least once or twice during a week long trip. I also endured long days huddled in my tent waiting for the rain to stop. Anything can happen on a mountain trail, even snow in August.

Along with gray skies, Washington is far enough north that the days are short in the winter time. As a young Registered Nurse I hated working day shift, which typically involved leaving for work before the sun had risen, and not returning home until after it had set. In those days it seemed like I lived in a perpetual world of darkness.

This darkness is the reason we want to retreat into our caves during the winter months, gather our furs around us, and eat chocolate. Chocolate, as it turns out, boosts serotonin levels, which is the reason we often crave it when we are having a bad day or struggling with depression during the winter months.

Yes, these dark days that persist for months are depressing. The popular term for it is the “winter blues,” but there is also a clinical term, “Seasonal Affective Disorder,” appropriately abbreviated S.A.D.

As a psychiatric nurse practitioner who lived and practiced in western Washington for many years, I obviously saw many S.A.D. patients in my office. I even worked for a few years at a mental health clinic in Forks, the scene of the popular Twilight novels. Reportedly the author chose Forks because of its nearly endless gray skies, and though she got a few things wrong in her description of the town, she was right about the gray skies. Week after week from early November until late February I would see people in my office who complained of feeling tired all the time despite sleeping more, gaining weight, craving sweets, and a persistently dark mood.

The recommended treatment for S.A.D. is light therapy, a fixture that is essentially a flat box of light that sits upright, allowing the user to glance at it several times a minute, usually used first thing in the morning to set the body’s mood clock.

Because I worked in community mental health for the duration of my career, most of my patients could not afford the expensive light box, so I was forced to offer alternative solutions. Fortunately there are good ones. Simply going outside and walking during the time of day when the sun is highest in the sky, from ten to two, can substitute for light therapy, and there are other benefits, promoting weight loss for example by increasing daily exercise. It is also helpful to increase the ambient lighting in the home by opening the blinds, clearing trees in front of windows, and turning on the lights.

I know about these things because I have suffered from S.A.D. for most of my life. I realize now after many years that I had to figure some of this out before I ever attended my first lecture on S.A.D. I have wondered at times if my fondness for hiking and backpacking has been motivated at least in part by my desire to be outside under the sun, to watch the light fade in the west as I pitch my tent on a ridge top, to awaken and warm up as it rises above the trees in the east. There has always been something comforting about this rhythm, and when it is lacking I am weighed down by it.

I was always surprised then when my patients seemed disappointed by this advice, as if they wanted something more sophisticated, a prescription for an antidepressant perhaps. “Get outside and go for a walk” often was just not good enough. It seems that we are always seeking complex solutions to simple problems.

Next week we make our transition to Standard Time, when daily rhythms go awry, and people with S.A.D. typically notice the onset of symptoms. Just the thought of this time change used to fill me with angst. Now I simply look at the front door. Open it. Go outside. Walk. This is the best advice I can give you.

*Cynthia Barnett in Rain: A Natural and Cultural History