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Many of us can identify with the winter blues—a post-Christmas letdown, perhaps exacerbated by cold weather and extended time indoors. But for some people this period of time is especially challenging and can interfere with their ability to manage their normal activities. Seasonal Affective Disorder, or SAD as it is more commonly known, is a category of depression that some people (perhaps as much as 5 percent of the U.S. population) experience recurrently on a seasonal basis. Symptoms usually begin in the fall or winter months in association with shorter days and less sunlight in the northern hemisphere and resolve in the spring. Many people who deal with this issue may begin to feel uneasy or notice mood changes even towards the end of the summer as they sense a shift to cooler weather; certainly, the time change around Daylight Savings Time in the fall can be a common trigger for those who live with SAD. There is also, however, a rare variant of the disorder which can occur seasonally in the summertime, known as Summer Depression.
While the DSM-V (the newest version of the Diagnostic and Statistical Manual of Mental Disorders) re-characterized this particular mood disorder in 2016 as Major Depressive Disorder with Seasonal Pattern, for the purposes of this article, we will utilize the colloquial term, SAD. Because approximately 70 percent of depressed people feel worse during colder, darker months of the year than during the summer, an important diagnostic distinction of someone suffering with SAD is that their depression is only present during this one time of the year (again, usually fall or winter) and goes into remission a few months later in the spring. One may suffer with SAD for as much as 40 percent of the year, but this type of depression can range anywhere from two weeks to nearly five months. This pattern must also be present for two consecutive years to be diagnosed as SAD. Likewise, a SAD diagnosis requires no nonseasonal depression (meaning less than two complete weeks of being depressed) during that two-year period, and one’s lifetime seasonal depressive episodes must vastly outnumber any nonseasonal depressive episodes.
Women and younger individuals are more likely to suffer with SAD than men or older people. Symptoms may resemble those of general depression, including a loss of interest in normal daily activities or activities which usually bring pleasure, feeling blue or sad for much of each day, irritability or agitation, disrupted sleep (sleeping too much or having difficulty getting to sleep or early wakening), general malaise/fatigue/low energy, and disrupted appetite with weight gain or loss. Trouble concentrating or thinking, trouble making decisions, thoughts of death or self-harm or suicidal ideation, and/or feelings of despair/hopelessness/worthlessness also typify SAD. Of course, if one experiences any of these symptoms intensely or for a significant period (more than a few days), feels particularly distressed beyond coping capacity, or feels actively suicidal, it is critical to seek professional help immediately.
While the nature and severity of SAD varies by individual, the disorder may also manifest more specifically by an increased desire for sleep and increased appetite, especially for comfort foods and carbohydrates, which in turn can cause weight gain. Thus, like some larger mammals such as bears, a recurrent seasonal desire to stock up on food and hibernate or isolate during winter months (with other symptoms of depression) could indicate that an individual suffers from SAD.
Treatment for SAD is similar to treatment for other forms of depression, with a few caveats. In general, SAD responds well to relevant psychiatric medications such as anti-depressants. Similarly, exercise—especially aerobic in nature—is helpful to increase endorphins and serotonin levels in our brains, which function to soothe and aid our feeling of well-being. Socialization and enhancing purpose, often through spirituality, is also crucial to reducing the effects of SAD, as in the case of other types of depression. Likewise, practicing good sleep hygiene and an appropriate nutritional eating program (cutting out added sugar and junk foods, taking Vitamin D if you are deficient) may help mitigate the effects of SAD. Significantly reducing or eliminating alcohol (which is a depressant), illegal drugs and other substances, or addictive habits that might fuel shame or lower self-esteem is also an important consideration. Finally, engaging in or returning to psychotherapy with a trusted counselor is always a good idea when confronting SAD, as with any form of depression.
The one additional treatment caveat that is especially germane to SAD is the use of a light box or light therapy of some type. This is because SAD specifically involves our body/brain’s response to decreased daylight and sunshine. Research suggests that daily exposure to phototherapy for about 30 minutes upon waking via a light box (a specialized box of lamps producing up to 10,000 lux of florescent light) that mimics sunlight and is about 20 times brighter than normal indoor light can alleviate SAD by helping your brain produce serotonin, a mood-enhancing hormone. One can also try to intentionally increase daylight exposure and possibly take a trip to a sunnier clime to enhance exposure to direct sunlight. Of course, during our current limitations with the pandemic, this last option is not as easy as purchasing a light box, but there is always “light at the end of the tunnel!”
[Note: it is critical to closely consult a physician or psychiatrist before using a light box, just as with any other medical treatment for depression, but especially if someone has been diagnosed with bipolar disorder, since phototherapy or certain medications can potentially trigger mania in some instances of bipolar disorder.]
Steven Alexander, Ph.D., is a licensed psychologist and therapist in the Halfway House program at Saint Luke Institute.
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