Many people have experienced sad-sack, lackluster days that seem to appear like clockwork with the onset of winter. Seasonal affective disorder (SAD) is characterized by unrelenting symptoms of depression that usually coincide with the fall and winter months, but a variant can also present in spring and summer. According to the DSM-5, SAD is a subtype of a major depressive or bipolar disorder. The symptoms for diagnosing depression with a seasonal pattern include having the following experiences for at least two consecutive years:
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 in which one experiences a normal mood
Many more seasons of depression than seasons without depression over the lifetime of the illness
SAD rates are highest in the regions furthest from the equator, with rates in Finland at 9.5 percent of the population, 20 percent in Ireland, 8.9 percent in Alaska and 10 percent in the Netherlands.
Research on SAD began in the United States in 1979 by Herb Kern. A research engineer who noticed he felt depressed during the winter months, Kern suspected the problem was caused by diminished daylight during these months. He presented the idea to scientists at the National Institute for Mental Health (NIMH) who, after studying the syndrome, devised a light box to help Kern with his depression. After a few days of treatment, his symptoms began to abate, as did other patients who also utilized the device.
Similarly, in 1984, Norman E. Rosenthal, M.D. and his associates at the NIMH, undertook the first formal study, again motivated by Rosenthal’s personal wintertime depression. He theorized that the reduction in natural light during the winter months was the cause of the depression. After documenting the placebo-controlled study results where light therapy was used, the findings were published. A subsequent book, authored by Rosenthal in 1993 called “Winter Blues”, became the standard introduction to the subject in professional circles.
Symptoms of SAD may include lack of energy, withdrawal from friends and family, decreased interest in activities that once brought joy, a tendency to oversleep and overeat, nausea and difficulty concentrating. These symptoms can culminate in pessimism, hopelessness and sadness, and thoughts of death or suicide.
For those who experience the syndrome in the spring and summer months, the symptoms are somewhat different. Although they, too, experience symptoms of depression, they also experience insomnia, anxiety, irritability, decreased appetite, social withdrawal, weight gain or loss and decreased sex drive.
Although most people with SAD are in the midst of a major depressive event, about 20 percent may have a bipolar disorder. It is important to distinguish between the two mental health disorders as there are important treatment differences. In patients with bipolar, spring and summer can bring on symptoms of mania or hypomania, where fall and winter triggers depression.
Treatment for SAD
Professional treatment for SAD is threefold: light therapy, medication and therapy. Light therapy, or phototherapy, involves seating the patient a couple of feet from a special light therapy box, exposing the patient to specific doses of light that mimics natural outdoor light and emits excessive lumens. One study, however, suggests that the blue light often used for SAD treatment be replaced by a green or white illumination for better results.
Selective serotonin reuptake inhibitor (SSRI) antidepressants have proven effective in treating SAD, particularly fluoxetine, sertraline and paroxetine. When utilized in conjunction with light therapy, drugs such as fluoxetine show a 67 percent success rate.
Psychotherapy, or talk therapy, is another helpful treatment modality. By sharing with a therapist the negative thoughts and behaviors that makes one feel worse allows the therapist to identify and teach healthy responses. A therapist can help a patient with SAD learn to cope with the symptoms and the stresses related to it.
Additionally, some lifestyle changes can go a long way in relieving SAD symptoms. Open the blinds, sit near a window at home or at work, if possible. Bundle up and take a leisurely walk or sit on a bench and soak up the sun. Even on a cloudy day, outdoor light can help elevate mood. Exercise regularly, as physical activity increases the “happy” chemical, dopamine, and relieves stress and anxiety, not to mention the many health benefits it produces.
Learning how to effectively manage seasonal affective disorder before it hits is key. By anticipating the annual gloom the change of season brings and making the necessary tweaks in environment and lifestyle, firing up the light box and making an appointment with one’s therapist, SAD can be managed and life can continue as planned.