Seasonal Affective Disorder
It’s that time of year again – Daylight Saving Time has ended and winter is a stone’s throw away, prompting the skies to gray and darken earlier. Along with the seasonal and time shifts, tend to come bleaker moods.
Seasonal affective disorder (SAD) is a form of depression also known as seasonal depression or winter depression. The Diagnostic Manual of Mental Disorders (DSM-5) identifies SAD as “Major Depressive Disorder with Seasonal Pattern.”[1] This disorder is particularly commonplace in the Pacific NorthWest, with its relentless rain and gray skies so famous that paint manufactured dubbed one hue “Seattle Gray.” If you’re curious what it looks like – just glance to the sky most days in winter in the PNW and you’ll know. Notably, the National Oceanic and Atmospheric Administration (NOAA) finds Seattle has some of the cloudiest weather in the country, with an annual average of 71 clear days, 93 partly cloudy and 201 cloudy.[2]
SAD is more than just “dreary winter blues.” Symptoms can be distressing and overwhelming to the point that they interfere with daily functioning. Roughly five percent of adults in the U.S. experience SAD, with durations lasting typically 40 percent of the year; symptoms tend to peak in January and February.[3]
Research has found shorter daylight hours and less sunlight in winter is linked to a biochemical imbalance in the brain. People can experience a shift in their biological internal clock/circadian rhythm that can cause them to be out of sync with their daily schedule.[4] The sleep-related hormone, melatonin, also has been linked to SAD as one’s body naturally increases melatonin production when it's dark; as days become shorter and darker, people have comparatively high levels of melatonin during normal wake-hours.[5] But for our sleep-wake cycle, it's important to pay attention to the fundamentals to those processes that regulate sleep. We have a circadian system that under normal circumstances, is very effective in promoting sleep at nighttime and wakefulness during the daytime.[6] In areas of higher latitudes (note: the PNW) where daylight hours wane in the winter, this disorder is more prevalent.[7]
SYMPTOMS AND DIAGNOSIS
According to the American Psychiatric Association[8], the two main/common symptoms of SAD include:
fatigue (even with increased sleep)
weight gain associated with overeating and carbohydrate cravings.
Additional symptoms of SAD are similar to those of major depression and can vary from mild to severe, such as:
Feeling sad or having a depressed mood
Loss of interest or pleasure in activities once enjoyed
Changes in appetite; usually eating more, craving carbohydrates
Change in sleep; usually sleeping too much
Loss of energy or increased fatigue despite increased sleep hours
Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable to others)
Feeling worthless or guilty
Difficulty thinking, concentrating, or making decisions
Thoughts of death or suicide
SAD may begin at any age, but it typically starts when a person is between ages 18 and 30, with risk increasing with age.[9] Further, demographically, this condition is more common among women than men.[10,11]
A diagnosis of SAD may be made after a careful mental health exam and medical history is conducted by a psychiatrist or other mental health professional.
TREATMENT
SAD can be effectively treated in several ways, including: light therapy, antidepressant medications, talk therapy or a combination of these methods. While symptoms will generally improve on their own with the change of seasons, symptoms can improve more quickly utilizing treatment.
Light therapy - This involves sitting in front of a light therapy box that emits a very bright light (and filters out harmful ultraviolet (UV) rays). According to the American Psychiatric Association, this method usually requires 20 minutes or more per day, typically first thing in the morning, during the winter months. Most people see some improvements from light therapy within one or two weeks of beginning treatment. To maintain the benefits and prevent relapse, treatment is usually continued through the winter. Anticipating the return of symptoms in late autumn, some people may begin light therapy in early autumn to prevent symptoms from arising.[12]
Those wishing to try light therapy, should speak to a specialist about which type of light is most effective. Dr. Lorin Boynton, a psychiatrist practicing at the University of Washington Medical Center-Roosevelt, notes, “You need 10,000 lux, so talk to a provider about what to get. Some people who have sensitive eyes shouldn’t use white light. They now make bright light therapy with green light that’s friendlier for the eyes.”[13]
Spending time outdoors - For some people, increased exposure to sunlight can help improve symptoms of SAD. Boynton suggests, “If you’re working out indoors, at home or at a gym, try to be in a brightly lit area, exercising outside whenever you can.” Further, research has shown that being in nature has a positive impact on health. “Natural daylight, even when it’s cloudy like it often is here, is much better for your brain and for all your hormones that control mood than artificial light.”[14]
Talk therapy, particularly cognitive behavior therapy (CBT) – Talk therapy has been shown to effectively treat SAD. Cognitive-behavioral or interpersonal therapy can help change distorted views one may have of themselves and the environment around them. Further, it can help improve interpersonal relationship skills, and identify things that cause stress as well as how to manage them[15.16]; this is particularly important as SAD leads to depressive symptoms.
Selective serotonin reuptake inhibitors (SSRIs) – This type of antidepressant is most commonly prescribed to treat SAD. SSRIs can help correct chemical imbalances that may lead to SAD.[17,18]
Maintain Health & Wellness – Ensuring your general health and wellness is optimized can also help. This includes: regular exercise, healthy eating, getting enough sleep, and staying active and connected (such as volunteering, participating in group activities and getting together with friends and family).[19]
Maintain your sleep routine - Dr. Ramanpreet Toor, a UW Medicine psychiatrist, notes that “Getting out of bed in the morning when it’s still dark out may be difficult, but maintaining a sense of normalcy by sticking to a regular sleep schedule will help your body better adjust to the lack of daylight.” Toor adds, “I wouldn’t recommend slowing down more or sleeping more; if someone is at risk of depression, that’s going to worsen symptoms.”[20]
The practice of good sleep hygiene is essential, including: keeping the bedroom cool and dark, avoiding caffeine near bedtime and putting blue light-emitting devices like smartphones and laptops away.[21] David Neubauer, of Johns Hopkins Medicine discussed sleep hygiene in an interview with Seattle Anxiety Specialists, PLLC: “We should be active in the daytime outside if possible. Sunlight is a good thing to help with the robustness of our circadian system, exercise, other physical activity.” Adding, “For our sleep-wake cycle, it's important to pay attention to the fundamentals to those processes that regulate sleep. We have a circadian system that under normal circumstances, is very effective in promoting sleep at nighttime and wakefulness during the daytime.”[22]
Keep variety in your diet - Once winter sets in, people tend to crave carb-rich and sugary foods become less inclined to cook. Boynton notes this is normal but should try to be avoided. Opt for healthy “comfort food” options like homemade soups or stews full of veggies and lean meats. Further, try to make meals colorful as possible by using different fruits and veggies to counter the dreariness of the weather. Aim to eat a diet which focuses on fruits, vegetables and whole grains.[23]
Johns Hopkins Medicine notes the following methods can further help relieve symptoms of SAD:[24]
Get help. If you think you may be depressed, see a healthcare provider as soon as possible.
Set realistic goals in light of the depression. Don't take on too much. Break large tasks into small ones, set priorities, and do what you can as you can.
Try to be with other people and confide in someone. It is usually better than being alone and secretive.
Do things that make you feel better. Going to a movie, gardening, or taking part in religious, social, or other activities may help. Doing something nice for someone else can also help you feel better.
Get regular exercise.
Expect your mood to get better slowly, not right away. Feeling better takes time.
Eat healthy, well-balanced meals.
Stay away from alcohol and drugs. These can make depression worse.
Delay big decisions until the depression has lifted. Before deciding to make a significant transition—change jobs, get married or divorced—discuss it with others who know you well and have a more objective view of your situation.
Remember: People rarely "snap out of" a depression. But they can feel a little better day-by-day.
Try to be patient and focus on the positives. This may help replace the negative thinking that is part of the depression. The negative thoughts will disappear as your depression responds to treatment.
Let your family and friends help you.
If you feel you have symptoms of SAD, seek the help of a trained medical professional. Just as with other forms of depression, it is important to make sure there is no other medical condition causing symptoms. SAD can be misdiagnosed in the presence of hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections, so proper evaluation is key. A mental health professional can diagnose the condition and discuss therapy options. With the right treatment, SAD can be a manageable condition.[25]
If you feel your depression is severe or are having suicidal thoughts, consult a doctor immediately, seek help at the closest emergency room or dial 911.
For more information, click here to access an interview with Psychiatrist David Neubauer on insomnia & anxiety.
Contributed by: Jennifer (Ghahari) Smith, Ph.D.
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 “Seasonal Affective Disorder (SAD),” American Psychiatric Association. (accessed 11-6-21) www.psychiatry.org/patients-families/depression/seasonal-affective-disorder
2 NOAA's National Centers for Environmental Information (NCEI). (accessed 11-6-21)
www1.ncdc.noaa.gov/pub/data/ccd-data/clpcdy18.dat
3 “Seasonal Affective Disorder (SAD),” American Psychiatric Association.
4 Ibid.
5 “Seasonal Affective Disorder,” Johns Hopkins Medicine. (accessed 11-5-21)
www.hopkinsmedicine.org/health/conditions-and-diseases/seasonal-affective-disorder
6 Naubauer, D., & Ghahari, J. (2021, August 24). Psychiatrist David Neubauer on Insomnia & Anxiety. Seattle Psychiatrist Magazine. (accessed 11-8-21) seattleanxiety.com/psychology-psychiatry-interview-series/2021/8/24/anxiety-and-insomnia
7 “Seasonal Affective Disorder (SAD),” American Psychiatric Association.
8 Ibid.
9 “Seasonal Affective Disorder,” Johns Hopkins Medicine.
10 Ibid.
11 “Seasonal Affective Disorder (SAD),” American Psychiatric Association.
12 Ibid.
13 “How to Survive - and Thrive - in the Pacific Northwest's Cold, Dark Months,” Right as Rain by UW Medicine. (accessed 11-5-21) rightasrain.uwmedicine.org/mind/mental-health/winter-motivation-tips
14 Ibid.
15 “Seasonal Affective Disorder (SAD),” American Psychiatric Association.
16 “Seasonal Affective Disorder,” Johns Hopkins Medicine.
17 Ibid.
18 “Seasonal Affective Disorder (SAD),” American Psychiatric Association.
19 Ibid.
20 “How to Survive - and Thrive - in the Pacific Northwest's Cold, Dark Months,” Right as Rain by UW Medicine.
21 Ibid.
22 Psychiatrist David Neubauer on Insomnia & Anxiety.
23 “How to Survive - and Thrive - in the Pacific Northwest's Cold, Dark Months,” Right as Rain by UW Medicine.
24 “Seasonal Affective Disorder,” Johns Hopkins Medicine.
25 “Seasonal Affective Disorder (SAD),” American Psychiatric Association.