Seasonal Affective Disorder

Have you ever noticed that when the season changes to the colder months, your mood and energy tends to diminish. It could be due to Seasonal Affective Disorder or Seasonal Depression. 

What is Seasonal Affective Disorder?

Seasonal Affective Disorder (SAD) is a form of depression, seasonal depression or winter depression. For people that with SAD experience mood changes and symptoms that similar to depression. The symptoms usually occur during the fall and winter months when there is less sunlight and usually improve with the arrival of spring. For some individuals the most difficult months in the United States are January and February. The experienced symptoms can be overwhelming and distressing, which can interfere with daily functioning. SAD has been linked to biochemical imbalance associated with shorter daylight hours and less sunlight in the winter months.  

What Causes SAD?

• Biochemical imbalance in the brain, featuring a lack of brain chemical serotonin.
• Winter there is only around eight hours of sunlight vs 16 hours at the peak of summer.
• Some individuals with certain brain chemistries are sensitive to the reduction in natural light.
• Light stimulates the pineal gland, which is located in the middle of the brain. It secretes substances that regulate the human biological clock.
• Some research suggested that people with SAD produce too much melatonin.
• Deficits in vitamin D may exacerbate these problems because vitamin D is believed to promote serotonin activity.
• Negative thoughts and feelings about the winter and its associated limitations and stresses are common among people with SAD.

Symptoms of SAD

Common symptoms of SAD are fatigue and weight gain. Symptom can range from mild to severe and can include many symptoms that are similar to depression such as 

• Feelings sad or having depressed mood.
• Loss of interest or pleasure in activities once   enjoyed
• Change in appetite; usually eating more, craving carbohydrates.
• Change in sleep; usually sleeping too much.
• Loss of energy or increased fatigue
• Increase in purposeless physical activity (inability to sit still, pacing, handwringing)
• Feel worthless or guilty.
• Difficulty thinking, concentrating, or making decisions.
• Thoughts of death or suicide

SAD can start at any age, but onset typically starts between ages 18 and 30. 

How Do I know If It’s SAD?

The basic hallmark of SAD is feeling overwhelming depression recurring every year during the winter and occasionally during the summer. In mild cases, the person may experience relatively little depression, may feel that their energy has dropped. The main symptoms to check for is that the depression is “seasonal”, that is, it starts and ends at times of the year (usually fall and spring). For the diagnosis of SAD to be made the following criteria has to be met

• The depression lasts for a period of at least 60 days between October/November and March/May.
• There must be three episodes, two of which are consecutive.
• Seasonal depression must outnumber other depressions by three to one.
• There should be no environmental factors or stresses, such as being unemployed or isolated.  from friends in winter

SAD can be just as severe and serious as other kinds of depression and if left untreated can impact the person’s quality of life. 

How Is SAD Diagnosed?

To be diagnosed with SAD, a person must meet the following criteria.

• The depressive episodes must occur during specific seasons (i.e., only during the winter months or the summer months) for at least 2 consecutive years. However, not all people with SAD do experience symptoms every year.
• The episodes must be much more frequent than other depressive episodes that the person may have had at other times off the year during their lifetime.

How Common Is SAD?

SAD may affect anyone and begin at any age but is believe that it starts between the ages 20 and 40. More women are affected than men. SAD has been documented in children and the elderly. SAD has been linked to other conditions, such as PMS. 

Treatment for SAD

Light therapy involves sitting in front a light therapy box that emits a very bright light (and filters out harmful ultraviolet rays). It usually requires 20 minutes or more per day, typically first thing in the morning, during the winter months. Most people do see improve from light therapy within one or two week of beginning treatment. To maintain the benefits and prevent relapse, treatment is usually continued through the winter.

Cognitive Behavioral Therapy can effectively treat SAD. It is aimed at helping people learn how to cope with difficult situations. CBT-SAD has been adapted for people with SAD (Typically 6 weeks and focuses on replacing negative thoughts related to the winter season (about the darkness of winter) with more positive thoughts). CBT-SAD also uses a process called behavioral activation, which helps individuals identify and schedule pleasant, engaging indoor or outdoor activities.

Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat SAD hen symptoms occur. SSRIs can help to enhance a person’s mood. Commonly used SSRI are Fluoxetine, Citalopram, Sertraline, Paroxetine, Escitalopram. Bupropion has been approved by FDA. It is an extended-release form, that can prevent recurrence of seasonal major depressive episodes when taken daily from the fall until the following early spring. 

Nutritional supplements of vitamin D may help improve their symptoms. Studies testing the effective vitamin D is effective in SAD treatment have proved mixed findings, with some results indicating that it is as effective as light therapy but other detecting no effect.

How To Help Yourself: An Action Plan

•Plan Fall activities 

•Think ahead about your winter routine 

•Be prepared for the holidays 

•Monitor your mood 

•Monitor your energy 

•Get more natural light 

•Lighten up your home and workspace

•Stay physically active

•Consider taking a winter vacation

•Consider relocating

•Seek help if necessary