Sad, SAD and Depression



    Dr. Sachin Mehta, medical director of the Mood Disorders Unit at Einstein's Belmont Center for Comprehensive Treatment, discusses why, for some, this isn't the most wonderful time of the year. 

    What To Do If This Isn’t The Most Wonderful Time of the Year


    Dr. Sachin Mehta, Medical Director, Mood Disorders Unit, Belmont Center for Comprehensive Treatment, Einstein Healthcare Network

    Have a case of “bah, humbug”? Feeling like a Jewish Grinch? Seasonal affective disorder (SAD) may be the cause. Thousands of Americans – specifically, those on the upper East Coast – are impacted by SAD. According to the National Alliance on Mental Illness, SAD is the result of reduced exposure to sunlight, which triggers a cascade of physical and mental reactions. Dr. Sachin Mehta of Einstein’sBelmont Center for Comprehensive Treatment sheds light on SAD and offers therapeutic remedies.

    What’s the connection between winter and SAD?

    It’s really about melatonin, Mehta explains, and the levels of it in our brains. “The good part of melatonin is that it helps us sleep, but the bad news is that too much melatonin is linked to depression,” he says. “In the winter, there is less sunlight because there are fewer daylight hours. Research has shown that sunlight on our skin stops melatonin from being released in our brain. Without that sunlight, melatonin levels increase, sometimes too much. That can lead to depression.”

    What’s the difference between the winter blahs and SAD?

    Mehta explains that are distinct symptoms of SAD. They include: persistent sadness, decreased interest in activities that usually provide enjoyment, too much sleep or not enough, eating too much or not enough, constant fatigue, trouble concentrating on activities and feeling worthless or having excessive guilt. Experiencing one or two of these feelings is normal, Mehta says. “Having five or more these symptoms for two weeks, qualifies as a major depressive episode,” he stresses. “In those situations – and certainly if someone is having thoughts of suicide – it is time to get help.”

    Will making lifestyle changes help?

    If reduced sunlight is part of the problem, increasing exposure to sunlight is worth trying, Mehta says. Get sunlight on your skin – your face or hands – for 45 minutes every day. Weather too cold to be outside? Open the blinds in your home or office. Don’t have a window in your office? Consider getting a light box. Phototherapy involves exposure to artificial sunlight and may help moderate melatoninlevels, Mehta says. Vitamin D, perhaps 400 units per day, has proven effective, as has exercise, which creates positive biochemical reactions. Adding fruits and vegetables to your diet is important, and mindful techniques like yoga and meditation can help with mood modulation.

    When is it time to get professional help?

    If these lifestyle changes don’t relieve the depression, see a mental health professional, Mehta advises. “But if you have suicidal thoughts even once, get help immediately,” he says. “And if you notice a friend, family member or coworker struggling – perhaps they stop going to work or stop returning phone calls – encourage them to get professional help right away.” There are many places to find that help. Crisis centers exist throughout Philadelphia, including at Einstein facilities. There are also peer-led support groups in the area. “Sometimes, just talking about the problem helps relieve it,” Mehta says. “There are also medications and other therapies that we can try. The most important thing is to take the first step towards getting help.”