Many people experience short time periods where they're feeling not quite like themselves or maybe a little sad. In some cases, these changes in mood start and end with the change of the seasons. They might begin feeling "down" as the days become shorter in autumn and winter, but start feeling better again come springtime when the daylight hours are longer. Sometimes, these changes in mood are more serious and have an impact on how they think, feel, and handle day-to-day activities.
As a sleep-care professional, if a patient tells you they notice substantial mood and behavior changes when the seasons change, they might be struggling with a type of depression known as seasonal affective disorder, or SAD.
What is Seasonal Affective Disorder (SAD)?
SAD, as mentioned, is a form of depression related to the changing seasons. It starts and ends at approximately the same times each year. In addition, most individuals with this condition, which is sometimes referred to as cabin fever or the winter blues, notice their symptoms start in the fall and continue through the winter months. Some people, although not as common, can develop SAD-related depression in the springtime or early summertime.
SAD is more common in young people, women, and people living far from the equator. People who are most likely to have this condition if one or more of their family members experiences depression.
Seasonal Affective Disorder Symptoms
Often, symptoms of seasonal affective disorder appear in the late fall/early winter and ease up during the spring and summer's sunnier days. Those who experience the opposite pattern, experience symptoms that start in the springtime or summertime. Either way, symptoms might begin mild and become more severe with the progression of the season.
1. SAD Symptoms in General
General seasonal affective disorder symptoms might include:
- Having low energy
- Experiencing depression most of the day, almost every day
- Feeling agitated or sluggish
- Having issues with sleep
- Displaying moodiness
- Feeling worthless, hopeless or guilty
- Having problems concentrating
- Losing interest in activities previously enjoyed
- Having frequent thoughts of suicide or death
2. Fall and Winter SAD
Winter-onset SAD specific symptoms (winter depression) might include:
- Appetite changes, particularly craving foods high in carbs
- Oversleeping
- Low energy or tiredness
- Weight gain
3. Spring and Summer SAD
Summer-onset specific symptoms (summer depression) might include:
- Weight loss
- Difficulty sleeping (insomnia)
- Anxiety or agitation
- Poor appetite
4. Seasonal Changes in Bipolar Disorder
In some individuals who have bipolar disorder, the springtime and summertime can bring on mania symptoms or symptoms of a hypomania (less intense form of mania) and the fall and winter can bring on depression.
Seasonal Affective Disorder (SAD) and Mood
SAD can often affect a person€™s mood. Feeling unmotivated, irritable, and lethargic during the winter months are common for those experiencing cabin fever. The long, dreary, and cold days and nights of winter that leads to people staying indoors is associated with winter doldrums. However, winter depression is a real thing for millions of individuals as well as its symptoms which include:
- Crankiness
- Inactivity
- Feeling down in the dumps
- Sleep loss
- General discontent
- Anxiety
- Loss of interest
- Anxiety
- Sadness
- Mood swings
- Loneliness
While many people feel better when they're around their friends and family, others are so cranky they believe it is better to isolate themselves from others.
Causes and Reasons
The specific causes and reasons for SAD remain unknown. Certain factors might come into play, including:
1. Serotonin levels. Serotonin is a neurotransmitter (chemical) in your brain that impacts mood. A drop in serotonin level may play a role in SAD. Decreased sunlight could cause a serotonin drop which could trigger depression.
2. Circadian rhythm (biological lock). The decreased sunlight level in fall and winter might lead to winter-onset SAD. This sunlight reduction could interfere with your body's circadian rhythm, leading to feelings of depression.
3. Risk factors. SAD can impact anyone, but it's more common in individuals living far south or north of the equator. This means you'll deal with longer days in the summertime and less sunlight in the wintertime. Other risk factors include:
- Age: Often winter SAD is initially diagnosed in individuals between ages18 and 30 and is not as likely to develop as you get older.
- Gender: Although three out of four SAD sufferers are women, men's symptoms are more severe.
- Family history: When you have family members who've had SAD or another form of depression, it increases your risk.
4. Melatonin levels. The seasonal change can interfere with the balance of your body's melatonin level. Melatonin impacts your mood and sleep patterns.
Seasonal Affective Disorder Treatments
Treatments for "summer depression" and "winter depression" or SAD often differ and may include any of the following (or a combination):
1. Sunlight exposure. Spending time outdoors or at least close to an open window could help to ease symptoms.
2. Light therapy. If it's not possible to increase exposure to sunlight, getting exposure to light at a special wavelength for a certain amount of time every day might help.
3. Psychotherapy. Interpersonal or cognitive-behavioral therapy helps to alter the distorted views people may have of the environment or themselves. Psychotherapy could help to identify things that cause them stress and improve interpersonal relationship skills as well as provide an understanding of how to go about managing them.
4. Antidepressants. Antidepressants could help to manage the chemical imbalance that causes SAD.
Seasonal Affective Disorder and Vitamin D
Vitamin D deficits might exacerbate SAD related problems since Vitamin D is thought to promote serotonin activity. Not only does the body consume Vitamin D through diet, it also produces Vitamin D when skin is exposed to sunlight. In the winter, when there is less daylight, individuals with SAD might have lower levels of Vitamin D, which could hinder serotonin activity even further.
Since many individuals with SAD have a deficiency in Vitamin D, nutritional Vitamin D supplements might help improve their symptoms.
Seasonal Affective Disorder and Bright Light Therapy
Light therapy has been a SAD treatment mainstay since the 1980s. The goal is to expose individuals with SAD to bright light daily to compensate for the reduced natural sunlight in the darker months.
This treatment involves the patient sitting in front of a 10,000 lux bright light box daily for around 30 to 45 minutes, typically in the early morning when they wake up. This continues from fall to spring. The light box is:
- Around 20 times brighter than regular indoor light
- Filters potentially damaging UV light out
- Provides a safe treatment for just about everyone.
However, individuals with specific eye diseases or those taking specific medicines that increase their sensitivity to sunlight might have to use a different treatment or only use this light therapy under a physician's close supervision.
For fall-onset SAD, light therapy is typically a first-line treatment. It usually begins working within the first few days to several weeks and doesn't cause many side effects. While there is limited research on light therapy, it does seem to be effective for most individuals in easing SAD symptoms.
Along with a professionally-tailored SAD treatment plan, there are some home and lifestyle remedies people affected by SAD can try. For instance, they should make their environment brighter and sunnier. They should get themselves outdoors when possible. They should take walks, or have a picnic at a park nearby. It's also helpful to get plenty of exercise since exercise or other forms of physical activity can help ease anxiety and stress - both of which increase symptoms of SAD. Not to mention, being fit helps lift mood and causes most people to feel better about themselves.
Whichever plan of SAD treatment you and your patient decide on, it is essential to combine it with other self-help remedies to manage symptoms of depression - and perhaps even prevent SAD from returning next year. Treatments can help not only improve the symptoms of SAD, but also your patient's quality of life since they will minimize or eliminate their sadness, anxiety, or other symptoms of SAD.