Here we are, in the middle of winter, with the bitter cold January temperatures, early sunsets, and dreary skies.
It’s common to feel sad and blue this time of year, and maybe a little irritable and moody. But sometimes the winter blues are more than that. When symptoms affect your quality of life, you may be struggling with seasonal affective disorder, or SAD. Sometimes called seasonal depression or winter depression, SAD is a type of major depressive disorder characterized by its seasonal pattern.
Treating seasonal affective disorder is important because left untreated, your quality of life can worsen. Some patients may experience suicidal ideation. Fortunately, there are many different ways we can treat SAD, and many patients see improvement with treatment.
Symptoms of Seasonal Affective Disorder
Symptoms of SAD tend to develop in the late fall and early winter and gradually improve in the spring and summer. To diagnose someone with SAD, we first need to diagnose the patient with major depression. Symptoms of major depression include:
- Loss of interest in enjoyed activities
- Depressed mood
- Lack of energy
- Change in appetite; people suffering from SAD tend to have increased appetite, crave carbs, and gain weight during winter
- Reduced ability to concentrate
- Self-loathing and feeling guilty or hopeless
- Moving too slow or being too fidgety
- Change in sleep patterns (insomnia or sleeping too much)
- Recurrent thoughts about death or suicide
If a patient is experiencing at least five of those symptoms, including either depressed mood or loss of interest in enjoyed activities for at least two weeks, we will diagnose the patient with major depression. If the symptoms occur during specific seasons at least two years in a row without another major depressive episode at another time of the year, we will diagnose the patient with seasonal affective disorder.
Those experiencing SAD during winter months may also sleep more, overeat and crave carbohydrates, gain weight, and lose interest in friends and family.
Though not talked about as frequently, some people do experience seasonal affective disorder during the spring and summer months. Symptoms of summer SAD include insomnia, poor appetite, and weight loss.
SAD Risk Factors
Approximately 5 percent of the U.S. population experiences seasonal affective disorder every year. Research has shown that women may be more likely than men to develop seasonal affective disorder. It most frequently affects those ages 20-40, and rarely affects children or older adults.
People who live in northern latitudes away from the equator and experience colder weather and shorter days are at higher risk for SAD, compared to those who live in Florida, for example.
Causes of SAD
There is a great deal of research into the causes of seasonal affective disorder. Though we don’t know the exact cause, some factors may include:
- Melatonin levels. Shorter days and longer nights disrupt melatonin levels, which can lead to SAD. Melatonin helps control sleep and wake cycles. With less sunlight, the brain secrets more melatonin, which can cause people to feel sleepy.
- Circadian rhythm (biological clock) irregularities. With the sun setting so early in the winter, many people get tired earlier in the day and the biological clock gets disrupted.
- Serotonin levels. Serotonin is a chemical that affects mood and creates feelings of happiness. Less sunlight means our bodies produce less serotonin, which can lead to SAD.
- Decreased light hitting the retinal receptors in our eyes. When our retinas aren’t being stimulated with light, we can develop seasonal affective disorder.
- Low levels of Vitamin D. We get Vitamin D from the sun. Vitamin D plays a role in mood, but most of us get less Vitamin D during the winter because we see less sunlight.
Treating SAD
Fortunately, we have many ways to treat SAD. Some patients benefit greatly from cognitive behavioral therapy, a type of talk therapy, to learn coping strategies and how to manage stress. Some patients do well with antidepressant medications, such as Prozac, Zoloft, or Lexapro. Vitamin D supplements can also be helpful.
Many patients see improvement with phototherapy, or light therapy. Patients can use a 10,000-lux light box for an hour or two a day, ideally before dawn. It’s best to sit about 18-24 inches away from the light box. Exposure to the light stimulates the brain and resets the circadian rhythms. Light boxes are sold at many retailers over the counter. Lifestyle remedies can also help treat — and even prevent — SAD, including exercising regularly, eating a well-balanced diet, and getting outside for fresh air, even on cold days.
We haven’t found that one type of treatment is far better than another. Each patient is unique. So if you are affected by SAD, work with your physician to develop the best treatment approach for you.
Treating SAD is vital. If left untreated, SAD can lead to other mental health problems, including suicidal ideation. If you or a loved one have suicidal thoughts, please call the Suicide and Crisis Lifeline at 988 right away.
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