With the sun rising later and setting earlier, many of us may notice a downward shift in mood around this time of year. Some people may brush this off as the “winter blues”, but it’s important to be able to recognize the signs in order to effectively combat this and improve your mood and wellbeing. Psychiatrists tell us Seasonal Affective Disorder (SAD) manifests differently than general sadness and depression. Let’s take a look.
What is Seasonal Affective Disorder?
SAD is indeed a subtype of clinical depression, however, while general (mild or moderate) depressive disorder can occur at any time, SAD manifests seasonally – usually appearing in fall and diminishing in spring. It generally affects people between the months of September and April, with a peak in December, January, and February.
The Diagnostics Statistical Manual (DSM 5) notes the criteria for diagnosis as:
- Depression is present only at a specific time of year (e.g. the autumn, winter) and full remission occurs at a characteristically lighter time of year (e.g. the spring, summer).
- Demonstrate at least 2 episodes of depressive disturbance in the previous two years, and seasonal episodes should substantially outnumber nonseasonal episodes.
- The episodes must be much more frequent than other depressive episodes that the person may have had at other times of the year.
Main symptoms:
- Hypersomnia (excessive sleepiness) and lethargy
- Trouble sleeping at night-time
- Cravings for ‘comfort foods’ rich in fats and carbohydrates
- Feelings of despair, stress, guilt, and anxiety
- Restlessness and irritability
The facts and figures
Statistics say women are more likely to receive a SAD diagnosis than men, at a ratio of 3:1. It’s more likely to appear at a young age, between 18 to 30 years old being the age bracket it generally appears. With Seasonal Affective Disorder affecting more than 1 in 20 people in the United Kingdom and America, it’s important to recognize the signs.
Comorbidity: SAD is more common in those diagnosed with MDD, bipolar II disorder, and anxiety/panic disorders.
What Causes S.A.D? Things to look out for:
Exact etiology and pathophysiology are still debated, however, SAD is thought to occur due to a combination of biological and environmental factors:
- Vitamin D deficiency
- Lack of sunlight
- Genetic predisposition
SAD occurs in the months when we receive less sunlight. A lack of sunlight keeps the hypothalamus from working properly, leading to circadian rhythm (internal body clock) disruption. When our circadian rhythms are disturbed, it affects our levels of melatonin and serotonin. Melatonin is the hormone responsible for making us sleepy, and it’s said that in people with SAD, this hormone is produced in higher quantities – leading to increased feelings of tiredness and lethargy. While melatonin increases, serotonin decreases. Serotonin is the hormone responsible for affecting our mood (and appetite), thus a reduction in serotonin can lead to low mood. This is why often in cases of moderate to severe depression, SSRIs (selective serotonin reuptake inhibitors) are recommended as part of the therapeutic intervention.
And, unsurprisingly, your location makes a difference. The further you are from the equator, the more likely you are to be affected by Seasonal Affective Disorder. To make a comparison, 1 percent of the population in Florida is affected, whereas it jumps to 9 percent of the population in Alaska – confirming that the darkness and shorter days are indeed at play here.
So how can we combat this?
As with most clinical disorders, a combination of therapeutic interventions is most effective.
Light Therapy
- Lightbox – A recent study showed that 60 to 80 percent of those diagnosed with SAD see improvements in their disposition.
- Sunrise Alarm Clock – These devices mimic the sunrise, so they can be really helpful during those darker and colder months, helping to maintain your body’s natural circadian rhythm.
Self-care
- Keep blinds and windows open
- Keep your home well-lit
- Exercise: spending time outdoors
- Mindfulness: Yoga, Tai Chi, Meditation
Medication
- Vitamin D supplements
- SSRI’s or mood stabilizers (A short course of extended-release medications such as Bupropion may be more effective in preventing seasonal depression episodes).
Nutrition
- Foods rich in Omega 3
- Foods rich in Vitamin D
- Foods rich in Folic Acid
- Berries
If you do notice patterns of low mood and lethargy and low mood in the winter months, consider that it could be SAD and that it is not something you have to endure without treatment and support. Talk to your health care provider about which treatment, or combination of treatments, is best for you.
