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    Seasonal Affective Disorder – More Than the “Winter Blahs”

    Janie Chappell, RN, MSN Manager of Community Services, Deaconess Cross Pointe 12/10/2019
    If you are one of the millions of Americans who finds themselves “in a funk” through the colder and darker months, you may be experiencing seasonal affective disorder, or SAD.

    SAD is a specific kind of depression that affects people seasonally. The vast majority are those who are affected during the colder/darker months. For reasons that aren't fully understood, some people develop depression that is considered to be related to less sunlight.

    SAD is a recognized mental disorder, and official diagnosis is related to these symptoms: 
    • Depression that begins during a specific season every year.
    • Depression that ends during a specific season every year.
    • No episodes of depression during the season(s) in which you experience a normal mood.
    • Many more seasons of depression than seasons without depression over the lifetime of your illness.

    More About Symptoms

    Although some individuals do not necessarily show all symptoms, the classic characteristics of SAD include:
    • Oversleeping
    • Daytime fatigue
    • Carbohydrate craving and weight gain

    Additionally, many people may experience other features of depression including:
    • Decreased sexual interest
    • Overall fatigue
    • Hopelessness
    • Suicidal thoughts
    • Lack of interest in normal activities
    • Decreased socialization
    • Significant irritability

    Some people report starting to feel this way in the fall, while others remain fine until January or so.  It can really vary from person to person.

    Other Factors Related to the Development of SAD

    While no specific gene has been shown to cause SAD, many people with this illness report at least one close relative with a related condition, such as depression. Scientists have identified that a chemical within the brain called serotonin may not be functioning correctly in many patients with SAD.

    The role of hormones, specifically melatonin, and sleep-wake cycles during the changing seasons is still being studied in people with SAD.

    Some studies have also shown that SAD is more common in people who live in northern/darker areas (e.g., Canada and Alaska as opposed to California and Florida).

    Treatment for SAD

    The role of talking with your doctor should not be overlooked.

    If you think you may have SAD--whether this is your first season, or you can look back and realize that it may have been happening for several years--you should talk with your doctor about it. A full medical evaluation of a person who is experiencing these symptoms for the first time should include a thorough physical examination as well as blood (e.g., thyroid testing) and urine tests (e.g., pregnancy testing, drug screening). A medical evaluation is appropriate because SAD can often be misdiagnosed as hypothyroidism or other medical conditions.  Also, there is some discussion about how vitamin D may be helpful in the treatment/prevention of SAD.  Again, discuss this with your doctor.

    Here are some treatments to consider.
    • Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.  Light therapy can be very effective.  (More on that in the next section.)
    • Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
    • Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.
    • Take care of yourself. Get enough rest and take time to relax. Participate in an exercise program or engage in another form of regular physical activity. Make healthy choices for meals and snacks. Don't turn to alcohol or illegal drugs for relief.
    • Practice stress management. Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
    • Socialize. When you're feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.
    • Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter SAD. 

    Light Therapy for SAD

    Many people with SAD will find that they feel better with light therapy. Light therapy consists of regular, daily exposure to a “light box,” which artificially simulates high-intensity sunlight. About 30 minutes or more daily in front of a light box can make many SAD patients feel better. In light therapy, also called phototherapy, you sit a few feet from a special light therapy box so that you're exposed to bright light. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

    Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to two weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.

    Scientific studies have shown light therapy to be very effective, and as effective as antidepressants in many cases of non-severe SAD. Light therapy may also work faster than antidepressants for some patients. Some people may choose treatment with both light therapy and antidepressant medications and find the combination of these treatments to be helpful.

    If you're prone to SAD, it's a good idea to start light therapy even a little before the time symptoms usually start. So if you know you're prone to SAD, and typically start feeling down in mid-November, perhaps you start your light therapy on Halloween.

    Light therapy boxes can be found online through various internet and other retailers, and sometimes at "natural" food/retail stores.

    Before you purchase a light therapy box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective.

    Health insurance companies rarely cover the cost, but a good light therapy box doesn’t cost thousands of dollars, or even several hundred.  The value in feeling so much better is hard to put a price tag on.  A light therapy box could be a great holiday gift request as well.

    More on Depression

    Finally, let’s talk about managing SAD—and even just a case of “holiday blues” caused by stress—through the winter months.

    The December holidays--even when they're happy--can take a toll on you.  All the change in routine, unusual foods, altered sleeping patterns, and the rush-rush-rush can leave you wrung out when they're over. If I had someone in my office describing feeling this way, I'd ask them about a few things:

    • Sleep.  Are you getting enough sleep now? What's the quality? Are you having trouble falling/staying asleep? Do you feel rested in the morning?
    • Weight changes. The holidays can contribute to this, but have you noticed any major changes up or down?
    • Emotional stability. Are you easily tearful?  Do you feel on-edge?
    • Vitality.  Do you have energy during the day? Do you enjoy aspects of your day, hobbies, etc?  Are you withdrawing in any way from family and friends?

    If these feelings are fairly mild, there are ways to improve how you feel by changing a couple of outlooks on things.
    • Stay connected with others (even if it feels like you're forcing yourself to at first). One of the greatest predictors of lifetime happiness is your relationships with others.
    • If your mental state is being affected by your finances, remember that happiness is not for sale.  "Retail therapy" can really cause more problems than it solves. If serious financial issues are weighing you down emotionally, it may be time to talk to a financial planner (or someone you trust who handles money well), and come up with an action plan. Sometimes these feelings are simply a result of feeling out of control.
    • Decide to make as many healthy lifestyle choices as you can. You are almost guaranteed to feel better overall if you have a balanced diet, limit any processed/junk food, and even just take a 20 minute walk every day. That can go a long way to helping press your mental "reset button."
    • Make some plans! Everyone needs something to look forward to. So make plans for a change in routine--whether it's a date night with your spouse, a weekend getaway, etc.

    However, if these aren't enough to resolve the "blues," it may be time to consider that there may be a more serious depression in place. 

    If you're struggling with holiday stress, I've published a separate blog article on this topic that affects many individuals. 

    Wishing you a healthy and happy holiday season.
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