Feeling SAD This Winter?
When you feel down during the colder months, is it just the “winter blues” or something more—like seasonal affective disorder (SAD)? Since you can’t step outside of yourself, it’s very difficult to self-diagnose. Instead, consult a trained physician or counselor. As third-party observers, these professionals can offer an unbiased perspective, help you identify lifestyle changes, and recommend treatments to restore your energy and productivity.
The following Q&A offers an overview of seasonal affective disorder. As you read, highlight or jot down anything that applies to you or that stimulates questions. Bring these notes to your therapist or doctor; with your assistance, he or she will be able to determine whether you could benefit from lifestyle changes, therapy, or other treatments.
What is Seasonal Affective Disorder (SAD)?
Also known as seasonal depression, SAD refers to a pattern of feeling depressed at the same time each year. It most commonly occurs during the fall and winter months.
SAD is more severe than “the winter blues” or “cabin fever.” It’s a type of depression that can get better with the right treatment, such as counseling or light therapy.
How common is SAD?
According to the Cleveland Clinic, roughly one-half million Americans suffer from winter SAD. Of these, 75 percent are women, and the symptoms typically appear during early adulthood (1). In Canada, an estimated two to three percent suffer from SAD at some point during their lifetimes; an additional 15 percent experience a milder seasonal depression that does not cause major life disruptions (2).
SAD is more common in cloudy regions and in locations far from the equator. It is also believed that SAD appears more frequently among women for two reasons: Women are more likely to stay indoors with children, and they’re more likely to report feeling depressed (2). However, men who feel less energetic or more irritable than usual during the winter months should feel free to seek help as well; discreet treatments are available.
What are the symptoms of SAD?
SAD shows many of the same symptoms as depression, such as:
- Sadness
- Anxiety
- Irritability
- Fatigue, lack of energy, or increased need for sleep
- Problems with sleeping
- Inability to concentrate
- Loss of interest in usual hobbies
- Withdrawal from social activities
- A “leaden” sensation in the arms or legs
- Changes in appetite or weight, especially craving carbohydrates
- Frequent thoughts of suicide or death
What causes Seasonal Affective Disorder?
No one knows for sure, but certain factors can make you more vulnerable to SAD:
- Reduced exposure to sunlight or living far from the equator
- Having a close family member with a mental illness
- Disrupted melatonin levels in the body
- Being diagnosed with clinical depression or bipolar disorder
If these factors apply to you, it does not necessarily mean that you will develop SAD.
Some scientists believe that for someone with these vulnerabilities, getting less direct exposure to sunlight may change the internal biological clock. This disrupts sleep patterns, mood, and hormones.
Other scientists believe that if certain chemicals in the brain become disrupted, this can lead to SAD. For instance, serotonin controls your mood; reduced sunlight exposure and SAD have been associated with low levels of serotonin.
What are the typical patterns of SAD?
Seasonal affective disorder is generally triggered by a change in seasons, particularly as the weather becomes cooler and sunlight becomes more sparse. Symptoms typically begin in October and November, although onset can occur as early as August or as late as January.
The depressive symptoms are usually mild to moderate, although some patients experience severe depression. In most cases, the symptoms begin to subside around March or April; patients often “feel like normal again” in early May.
What are the potential complications of Seasonal Affective Disorder?
If not treated, SAD can become more severe and lead to life problems including:
- Social withdrawal
- Problems at work or school
- Substance abuse
- Suicidal thoughts or behavior
By working with your doctor and therapist, you can prevent or lessen these complications through effective treatment methods.
How is SAD diagnosed?
To determine whether you have seasonal affective disorder, your physician may perform a thorough evaluation consisting of:
- Physical exam – to rule out underlying physical health problems that could cause depressive symptoms
- Lab tests – to rule out your thyroid and blood cells as a cause of your depressive symptoms
- Psychological evaluation – to check for signs of depression
If all other possible causes of your symptoms have been eliminated and your psychological evaluation indicates depression, then you may be given a diagnosis of seasonal affective disorder.
How is SAD treated?
Depending on the specifics of your case, some or all of the following treatment options may be recommended:
* Light therapy (Phototherapy)
Often used as an initial treatment, this method works well for patients with mild to moderate depression who are unable or unwilling to take antidepressant medications. This treatment involves sitting in front of a “light box” for 30 minutes every morning, shortly after awakening. To prevent symptoms from returning, light therapy should be repeated daily from the first onset of symptoms and through the winter months. Side effects are uncommon, although some patients may experience headache, eye strain, fatigue, irritability, or insomnia.
Unfortunately, simply turning on all the lamps in your house is not as effective as using a light box; in order to imitate sunlight, this therapy requires a specific type of light that house lamps cannot provide. In addition, do not use tanning beds to treat SAD; tanning beds emit too much ultraviolet (UV) rays, which harm the skin and eyes.
Clinical studies indicate that light therapy is extremely effective, sometimes creating noticeable improvement within a few days. Other patients need a few weeks of daily light therapy before they begin to feel better.
* Antidepressant medications
Antidepressants can also be effective in reducing the symptoms of SAD, particularly Prozac (fluoxetine) and Wellbutrin (buproprion) for moderate to severe seasonal depression. These medicines should be taken daily, ideally at the same time of day. Most patients report improvement starting after a few days or weeks on medication.
In some cases, medication can also be used to help prevent depressive episodes for patients who have had SAD in the past.
* Counseling (Psychotherapy or Cognitive Behavior Therapy)
Working with a trained counselor can help you identify and change negative behaviors or thoughts that can exacerbate SAD, learn new and healthier coping methods, and improve your stress management skills. These enhancements can help reduce your depressive symptoms, regain control over your life, and even improve your quality of life during other parts of the year.
* Exercise
Regular exercise stimulates the release of endorphins within your body, which in turn makes you feel more positive. In cases of mild to moderate seasonal depression, exercise can relieve symptoms while strengthening your body and raising your self-esteem. Generally, moderate exercise is enough to stimulate improvement. Common examples include:
- Yoga
- Walking
- Swimming
- Biking
- Gardening
- Dancing
- Housework, especially mopping, vacuuming, or sweeping
- Low-impact aerobics
- Jogging at a moderate pace
- Tennis
- Yard work, especially raking or mowing
- Community center programs
Before embarking on an exercise regimen, work with your physician to determine the best type of exercise for you. Begin your exercise routine gradually, building up to 20 to 30 minute sessions conducted three to five times a week. Remember to include variety so you don’t get bored.
* Lifestyle remedies
Home and lifestyle remedies center around increasing your exposure to sunlight. For instance, you can go outside more often, even if it’s just taking a walk. It doesn’t matter if the weather is cloudy or cold; every bit of outdoor light will help, especially if you head out within two hours of waking up each morning.
When you’re stuck indoors, try opening the curtains. Trim any tree branches that block sunlight from your windows and consider adding skylights throughout your home. Sit close to bright windows whenever possible.
* Herbal and natural remedies
In cases of mild or moderate seasonal depression, certain herbs or supplements can provide symptom relief. Check with your doctor or pharmacist before starting a regimen of herbal supplements as they might interfere with other medications that you’re currently taking.
- St. John’s Wort – This home treatment, available as a tablet or solution to be added to your beverage, is widely used in Europe to treat depression.
- Rhodiola – This herb has been used for thousands of years to treat SAD, enhance immunity and memory, strengthen the nervous system, and more.
- 5-HTP (5-hydroxytryptophan) – Since serotonin is made from 5-HTP in the body, taking extra 5-HTP can help boost depression-fighting hormones naturally.
- Melatonin – This hormone is naturally produced by your body, but a disrupted melatonin level could cause or worsen SAD. Taking synthetic melatonin could help restore balance.
Can you prevent Seasonal Affective Disorder?
If you’ve experienced SAD in the past, there are several things you can do to reduce or eliminate symptoms this winter:
- Start using a light box, even before you feel symptoms.
- Spend some time outdoors every day, even on cloudy days.
- Exercise for 30 minutes at a time, three times a week.
- Stay involved with your social activities; friends provide invaluable support.
- Work with a therapist, even before symptoms begin.
- If your symptoms were severe in previous years, talk to your doctor about taking antidepressant medication.
When should you see a doctor for SAD?
If you are experiencing any of the symptoms described above, consult your doctor or therapist. He or she will conduct a thorough examination to determine whether you are suffering from SAD, another mood disorder, or even another medical condition that mimics the symptoms of SAD.
Similarly, if you feel sad or “down” most days, or if everyday tasks feel overwhelming, schedule a visit with a trained professional. Whether or not you have SAD, help is available so you can feel better and take care of yourself and your loved ones properly through the winter months.
What should you do if you think a friend or family member might have SAD?
Most of all, offer your support in a non-judgmental manner. Encourage him or her to seek professional assistance, and convey that it’s OK to ask for help.
If the symptoms become severe, to the point of considering suicide, call the doctor immediately or go to the closest emergency room.
Final Comments
It’s OK to feel down every once in a while, but nobody should feel down all the time. If you’ve been lethargic, apathetic, or sad recently, you don’t have to remain this way. Ask your doctor or therapist about seasonal affective disorder and how you can take back control of your life, your health, and your mood. You are a valuable person and you deserve to feel better!
References:
(1) Seasonal Depression. (2013, November 12). Retrieved December 27, 2014, from http://my.clevelandclinic.org/services/neurological_institute/center-for-behavorial-health/disease-conditions/hic-seasonal-depression
(2) Seasonal Affective Disorder. (2013). Retrieved December 30, 2014, from http://www.heretohelp.bc.ca/factsheet/seasonal-affective-disorder
http://www.herbwisdom.com/herb-rhodiola.html; http://www.heretohelp.bc.ca/factsheet/seasonal-affective-disorder
http://www.life-enhancement.com/magazine/article/247-make-spring-come-sooner
http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/basics/alternative-medicine/con-20021047
http://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=23051
http://www.webmd.com/depression/guide/exercise-depression
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