Should I Take Antidepressants for Winter Blues?

By Dr Fred Kavalier

I GET SAD – AND IT’S WORSE EACH YEAR

I suffer from "winter blues" lethargy caused by lack of sunlight. Although I am pulling out of it now that spring is here, I am aware that it is getting worse each year, despite global warming and spending three days a week outside. Last summer, I questioned my GP, who said that light treatment does not work that well. He suggested a course of mild antidepressants over the winter months. I do not rate myself as depressed, so it does not seem that logical to take antidepressants. What treatments might help?

SAD, which stands for seasonal affective disorder, is the fancy medical name for this. The theory is that the change of seasons, or lack of sunlight, somehow affect the brain and cause at least some of the symptoms of depression. When the light returns again in the spring, the symptoms disappear. A small number of people seem to have the problem in reverse – they get worse in the summer and better in the winter.

I think you are wrong to think it is not a form of depression. Women are more prone to SAD than men, and it seems to get commoner with increasing age. The most usual symptoms of winter depression are increased sleep, increased appetite, weight gain, irritability and problems with relationships (especially feelings of rejection). There is some evidence that light therapy helps, but it is not effective for everyone with SAD. You have to sit in front of a specially designed light box every day for 30-90 minutes. People who respond to this treatment often begin to feel better within days. I don’t think a winter course of antidepressants is a bad idea, but it depends on the symptoms you get and how severe they are. As with other forms of depression, another treatment option is cognitive behaviour therapy.

MYSTIFIED BY SENSATIONS OF COLD

I am a 60-year-old male and have a problem with cold sensations down the outside of my left arm and leg. Sitting in a heated room does not improve the chilling sensation, and neither does a blanket. The only way to warm the outside of my arm and leg is to sit with radiant heat on my left side. This problem has been with me for eight years. No one seems to have any idea what the cause of it is.

This is an unusual and slightly bizarre symptom. I am not surprised you have been unable to find an explanation for it. Our ability to sense temperature is controlled by a specific part of the brain. If there has been damage to that part of the brain, this may disturb your appreciation of temperature. The problem with your symptom is that it affects such a limited section of the body, and it is difficult to imagine which part of the brain might be responsible for just the outside of your left arm and leg.

If the symptom began suddenly one day, I think the likelihood is that you suffered a very minor stroke that damaged a small area of the brain responsible for temperature sensation on the left-hand side of your body. A specialist neurologist might be prepared to investigate this further with an MRI scan of the brain. There’s not going to be any effective treatment for your symptoms, but if you have had a small stroke, it would be important to make sure that risk factors such as blood pressure and cholesterol are under good control.

WHY HAS MY BREAST MILK COME BACK?

I stopped breast-feeding my second child about 18 months ago, but recently I have noticed milk leaking from my breasts for no apparent reason. It is only a small amount, but it is now happening most days, particularly in the mornings. The health visitor told me it was likely to be a remnant of breast-feeding, but nothing similar happened after I weaned my first baby. Is this something to do with feeding more than one child?

Spontaneous leakage of milk from the breasts in women who are not pregnant and not breast-feeding is not normal. If you are definitely not pregnant, there are several possible explanations. Some drugs can cause milk production – the most likely ones are drugs used to treat mental illness and depression, and for high blood pressure. But there is a long list of other drugs that could be the culprit. If you are taking any medicines at all, read the package inserts to see if milk leakage – also known as galactorrhoea – is a recognised side-effect. Even some herbal remedies can cause this.

If it is not a side effect of a drug, it may be caused by raised levels of the hormone prolactin, produced by the pituitary gland. A blood test can check your prolactin levels. Low thyroid hormone levels can push up prolactin levels, so get that checked too. Also, consider nipple stimulation; jogging in a loose bra, or erotic stimulation of the nipples, can stimulate milk release.

Readers write

JP, London, on Duraphat toothpaste: Mydentist recommended Duraphat for sensitive teeth three or four years ago, but I was highly sceptical. However, it has been

brilliantly effective. I have been able to buy it fromthe two dentists’ surgeries I have used since, fromthe receptionist, over the counter without a "prescription".

How JT, from Oxford, cured her clicking jaw: I had trouble with a clicking jawon and off for many years. I found that itwas helped by having lessons in the Alexander technique. On the very rare occasions that it recurs, I can sort it out formyself nowby applying what I learnt then.

(c) 2007 Independent, The; London (UK). Provided by ProQuest Information and Learning. All rights Reserved.