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The NSPA Blog

The Spotlight on Seasonal Depression

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Posted on October 21st, 2019 by Bettina Carlson, under Mental Health, Patient Advocacy, Take Charge

The weather is getting colder, the days are getting shorter, and we have less daylight exposure. And we all have heard it, or maybe we are the ones who noticed it ourselves, the claim that our moods are getting darker, too. And indeed there are studies that confirm that weather and seasons do impact our mind and spirit, or in other words our psyche. 

But we don’t really need studies to know that we respond to weather and light. When it’s cold we shake, when it’s hot we sweat, when it rains and it’s cold we shiver, when it gets dark we start to get tired; it’s our bodies physiological response to our environment. The difference is, we don’t all respond the same way. Some of us experience these physiological responses more intensely than others.  For some it’s just the “Winter Blues”, and the affected can toughen this out. But when the response is quite serious and significantly impacts the psyche of the individual, many times they are diagnosed with Seasonal affective disorder (SAD). And for that they need additional support.  

SYMPTOMS OF SAD

So, what is SAD? Let’s shine some light on it! Yes, pun intended! 

SAD is a category of depression that occurs during the same time every year, usually beginning in the fall, and increasing throughout the winter. But in a few cases SAD can also start in the spring and increase throughout the summer. 

According to the National Institutes of Mental Health (NIMH), “to be diagnosed with SAD, people must meet full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least 2 years. Seasonal depressions must be much more frequent than any non-seasonal depressions.” (https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml)

What are those symptoms? Mayo Clinic lists the following symptoms (https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651).

Signs and symptoms of SAD may include:

  • Feeling depressed most of the day, nearly every day
  • Losing interest in activities you once enjoyed
  • Having low energy
  • Having problems with sleeping
  • Experiencing changes in your appetite or weight
  • Feeling sluggish or agitated
  • Having difficulty concentrating
  • Feeling hopeless, worthless or guilty 
  • Having frequent thoughts of death or suicide

Fall and Winter SAD

Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:

  • Oversleeping 
  • Appetite changes, especially a craving for foods high in carbohydrates
  • Weight gain
  • Tiredness or low energy 

Spring and summer SAD

Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include:

  • Trouble sleeping (insomnia)
  • Poor appetite
  • Weight loss
  • Agitation or anxiety 

COMPLICATIONS 

If you experience any combination of these symptoms, and if they start to interfere with your daily life, no matter how small at first, take action and seek help. If left unattended SAD can lead to serious problems: 

  • Social withdrawal
  • School or work problems
  • Substance abuse
  • Other mental health disorders such as anxiety or eating disorders
  • Suicidal thoughts or behavior

CAUSES OF SAD

We don’t know the specific causes for SAD yet. But as I said above, we know, the weather is guilty! But how is the weather responsible for the incidence of SAD?

Researcher have identified a relationship between sunlight and mood.  The reduction of sunlight in the fall and in the winter can mess up our biological clock by reducing levels of serotonin, also known as the “Happy Hormone”, which is responsible for regulating sleep and mood. And it can reduce the levels of melatonin, which plays a role in regulating sleep and mood.  

Anecdotally, and statistically, we find more incidences of SAD in countries far from the equator with less sunshine year round; whereas in countries close to the equator, with lots of sunshine, we find fewer incidences of SAD. For example, 1 percent of those who live in Florida and 9 percent of those who live in New England or Alaska suffer from SAD. (https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml).

WHO IS AT RISK?

According to the NIMH, attributes that may increase your risk of SAD include:

  • Women are four times more likely to be diagnosed with SAD. (But that could be due to the fact, that women are more likely to go their doctor and seek help for their symptoms).
  • People with a family history of any type of depression are more likely to develop SAD than people without such family history.
  • SAD is more common in younger age people and can start as early as in young adulthood. 
  • If you already have depression or bipolar disorders, the symptoms of depression may worsen with the seasons. (But SAD is diagnosed only if seasonal depressions are the most common).

TREATMENT

There are several treatment options. And it comes as no surprise that light therapy is one of them. And it is very successful. 

Once again, I find myself quoting the Mayo Clinic

Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Light therapy

In light therapy, also called phototherapy, you sit a few feet from a special light box so that you’re exposed to bright light within the first hour of waking up each day. 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 a few 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.

Before you purchase a light 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. Also ask your doctor about how and when to use the light box.

Medications

Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.

An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD.

Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.

Psychotherapy

Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you:

  • Identify and change negative thoughts and behaviors that may be making you feel worse
  • Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities
  • Learn how to manage stress

Mind-body connection

Examples of mind-body techniques that some people may choose to try to help cope with SAD include:

  • Relaxation techniques such as yoga or tai chi
  • Meditation
  • Guided imagery
  • Music or art therapy

FINALLY

What can you do to prevent SAD? Before you even need treatments! While it seems fairly easy, it is actually quite challenging for most of us on most days, and even more so for the affected – it is to spend as much time outdoors in nature. Get as much daylight as possible, get as much fresh air as possible, get as much physical movement as possible. If you walk with a friend or spouse or child, you also get a good dose of social interaction. 

When it’s cold, wet and possibly dark, this seems like such an impossible option, you just cannot motivate yourself. This is real, we hear it over and over again. So don’t think! Count backwards from 5 … 5-4-3-2-1 and then go!! You might find yourself surprised because it might very well work for you! You have a 100 percent of succeeding if you give it a try!

SOURCES AND RESOURCES

National Institutes of Mental Health. https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml

US National Library of Medicine. National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673349/

Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651


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