Take a look at the image. Many would find it starkly beautiful. But for those struggling with seasonal affective disorder, it likely equates to emptiness, loneliness, and bitter cold. It can be a tough time of the year.
Winter depression is the most common type of SAD; however, there’s a milder form known as ‘winter blues.’ Much less common is summer depression…
Well, now it’s prime time and millions are reaching out for help.
Bumped into an article on Psychiatric Times that delivers a portion of that help. “A Way Out of Seasonal Depression,” written by psychiatrist Dr. Anoopinder Singh, is loaded with quality information. I was so impressed that I’m going to highlight and summarize it for you.
As is my custom, for the sake of reading flow, I’m not going to repeatedly hit you with “According to Dr. Singh…” However, I assure you that my words are all about his work and writing.
Okay, let’s get after it…
What is seasonal affective disorder?
The symptoms of seasonal affective disorder (SAD) typically include a persistently low mood and lack of energy (real or perceived). Also experienced may be irritability, crying easily or frequently, lethargy or tiredness, decreased activity, hypersomnia, sugar and carbohydrate cravings, weight gain, social withdrawal or disengagement, and difficulty concentrating.
Winter depression is the most common type of SAD; however, there’s a milder form known as “winter blues.” Much less common is summer depression, which occurs in the spring and summer months.
SAD tends to peak from December through February when shorter days mean less sun. But keep in mind, it can last up to 40% of the year.
Diagnostic criteria and stats
According to the DSM-5, to be diagnosed with SAD (major depressive episode with a specifier of “with seasonal pattern”), one has to experience an episode during a specific time of the year for at least two years.
SAD annually affects some 5% of the adult population. It presents more frequently in those with a family history of depression, as well as younger people. SAD’s average age of onset is between the ages of 18 and 30. Those who are engaged in shift work – healthcare workers, law enforcement, etc. – are at higher risk.
Lack of sun is the primary cause of SAD. Also playing a role can be a series of cloudy days, spending most of one’s time indoors, and adjusting to time changes.
Whether it’s winter depression, winter blues, or summer depression, SAD can cause significant impairment in functioning. Even suicidal ideation is on the table.
How SAD affects the body
Okay, the primary cause of SAD is lack of sunlight. But something has to happen in the body to put the wheels in motion. Right?
Well, low sunlight leads to higher levels of the serotonin transporter protein, which can result in a decrease in serotonin activity in the brain. So, mood takes a dive.
Lack of sunlight can also generate an overproduction of melatonin, the sleep-wake regulating hormone. Of course, that can cause sleepiness and lethargy.
All of these changes to serotonin and melatonin levels can wreak havoc upon one’s circadian rhythm. So, it’s no wonder that people with SAD tend to have greater difficulty adjusting their internal clocks to seasonal changes in day length. And that can lead to sleep, mood, and behavior challenges.
Finally, vitamin D levels are also affected by light, impacting the supply of serotonin. As you likely know, in addition to being found in certain foods, vitamin D is produced by the skin when exposed to sunlight.
How to treat SAD
So, an individual has had enough of SAD and is ready to seek relief. Fortunately, there are numerous treatment options…
- Medication: Antidepressants may provide relief. Keep in mind, there are numerous classes of antidepressants with a good number of meds in each. So, if one doesn’t work, there are others to turn to.
- Neuromodulation: Advanced medical device technology to enhance or suppress activity of the nervous system. Included for the treatment of depression: deep brain stimulation (invasive), transcranial magnetic stimulation, transcranial direct current stimulation, trigeminal nerve stimulation, vagus nerve stimulation. Electroconvulsive therapy (ECT) is not a form of neuromodulation.
- Psychotherapy/counseling: Can help to significantly reduce distress and impairment. If the depression is mild, it may be effective on its own. But for moderate to severe cases, it’s frequently used in combination with meds. Though cognitive behavioral therapy is considered the most effective, there are others worth considering: mindfulness-based stress reduction, positive psychotherapy, interpersonal psychotherapy, brief problem-focused therapy.
- Light therapy: The idea is to reverse the effects of diminished sunlight by exposure to an artificial full-spectrum light. It’s similar to natural sunlight, but the ultraviolet light is filtered out. Medical supervision is suggested to ensure appropriate light intensity, distance, duration, frequency, and timing. Doing so will aid in sidestepping unwanted effects such as headaches, eyestrain, and, in rare cases, mania and suicidal thoughts. Before using light therapy, one needs to make sure they aren’t taking meds that may cause an unusual sensitivity to light. Light therapy is usually recommended for morning use. Light boxes are easily available, often without a prescription
- Vitamin D supplements: Clinical studies suggest that people with SAD have insufficient (mild or borderline-low) or deficient (significantly low) vitamin D levels. It’s caused by a combination of reduced intake through diet and sunlight exposure. Research suggests that daily supplementation with moderate to high dose vitamin D may improve or even prevent symptoms of SAD. Although rare, there is a risk of adverse effects or toxicity when using a very large dose of vitamin D. So, it’s always a good idea to work with a doc.
- Lifestyle: Find ways to reduce stress, increase physical activity, spend more time outdoors, eat a diet high in protein – as well as complex carbohydrates and vegetables, avoid fatty foods and simple carbs. And how ’bout travel to sunny destinations?
- Other options: Dietary supplements, mindfulness and meditation practices, yoga, acupuncture – the list is lengthy. One needs to make careful choices because supplements aren’t regulated. Again, it wouldn’t hurt to chat with a doc.
Keep bringing the light
Seasonal affective disorder is too often minimized and not given the attention it deserves. If you’re struggling with it, you know it can be brutal.
Yes, it’s a tough time of the year – seasonal affective disorder prime time. If it’s a part of your life, learn all you can so you can be doing your best to manage.
Keep bringing the light.
Take the time to read Dr. Singh’s article on Psychiatric Times, “A Way Out of Seasonal Depression.” And while you’re there, do some browsing – lots of interesting and helpful information.
Looking for more insight and help? Well, just you review those Chipur titles.