Some people, and this whole may de facto be larger than once supposed, do not do well in the winter. They organize a severe mood disorder that has been referred to as seasonal affective disorder. Sad may be more tasteless in patients already suffering from fibromyalgia.
Modell and colleagues studied 226 patients with Sad and found that it de facto was a syndrome consisting of multiple symptoms (Modell, Jg, et al. Biol Psychiatry. 2005; 58: 658-667.) These consisted of depression, fatigue, group withdrawal, anxiety, feelings of guilt, carbohydrate craving, insomnia, increased appetite, weight gain, and gastrointestinal symptoms. The onset of these symptoms may simulate a fibromyalgia flare. And in fact, there is very diminutive disagreement from a clinical viewpoint. Symptoms begin in the late fall and continue through the end of March with January and February being the worst month for symptoms.
Sad is felt to be due to abnormal functioning of the pineal gland at the base of the brain. The normal circadian rhythm is regulated by the pineal. The pineal gland secretes melatonin in the evening and shuts off melatonin while daylight hours. Dysregulation of melatonin secretion, both in the whole as well as the timing appears to be the major glitch. Srinivasan proposed that the morning fatigue- non-restorative sleep- occurring with Sad could be due to prolonged melatonin secretion in the morning (Srinivasan V, et al. J Biol Psychiatry. 2006; 7: 138-151.)
Treatments for Sad should be well-known to fibromyalgia patients. The first involves use of a light box for 30 minutes in the morning. Theoretically, this should shut off pineal secretion of melatonin because of the light exposure on the eyes. A light box has to be high intensity emitting at least 10,000 lux. A collection of these “sun boxes” are available. They cost approximately 0-600. The light box should be used after consulting with your curative specialist. truthful adherence to instructions will help prevent eyestrain and headaches.
Alternatively, selective serotonin reuptake inhibiting medicines (Ssris) may also be used. The drug that has been studied the most is Prozac. While usually well tolerated, it does have potential side-effects together with palpitations, sleep disturbance, and loss of libido.
Melatonin taken in a small dose (0.1 mg) in the late afternoon may also be sufficient for Sad. This dose is small adequate not to cause drowsiness but is adequate to make the pineal gland reset the body’s biological clock. Since the usual over-the-counter dose is 3 mgs, a inpatient may need the help of a compounding pharmacy to be able to get the tiny 0.1 mg dose.
Combining the low-dose melatonin with a light box also seems to be effective.
Exercise is an additional one rehabilitation that is useful. Non impact aerobic rehearsal helps stimulate blood flow, increases energy, and stimulates endorphin output in the brain. All of these help with the fatigue and mood problems that occur with both Sad and Fm.
Finally cognitive behavioral therapy should not be neglected. It is a cornerstone of Fm care and also is beneficial for Sad.
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