Leaves are changing colors, pumpkins adorn porches, and spice can be found in everything from coffee to candles. While fall brings a relief from the heat and a welcomed change of pace to many, for some, the season marks the onset of a dark time.
SEASONAL AFFECTIVE DISORDER
Seasonal Affective Disorder (SAD) is a type of depression defined by its relationship to the change in seasons. For most individuals affected by SAD, symptoms begin in the fall and continue through the winter months. Most patients experience relief in the spring and summer, while a smaller number of individuals may experience a predominately spring/summer symptom onset. Patients with SAD will experience a recurrence of symptoms starting at almost the same time every year. Many times, people with SAD feel a general loss of energy and low mood that does not improve over a few days or with rest. In patients with predominately fall/winter SAD, symptoms include oversleeping and weight gain with patients often turning to high carbohydrate, calorically rich foods for comfort. Additional symptoms may include decreased concentration, feelings of worthlessness, and increased guilt.
Seasonal Affective Disorder is not a unique disorder, but a subtype of depression that mainly affects individuals four to five months of the year. While the exact cause is not fully known, as with other types of depression, there is usually an interplay of genetics, environment, nutrition, and social factors. Studies have shown abnormal levels of neurotransmitters, specifically, lower levels or reduced function of serotonin, a neurotransmitter involved in mood regulation. Serotonin levels have been shown to be affected by sunlight exposure (usually reduced in the fall/winter months of the year) and Vitamin D metabolism (also affected by sunlight). Further, melatonin, a neurochemical essential to the sleep-wake cycle has also been shown to be elevated in patients with SAD. Socially, individuals may experience boredom with reduced outdoor activities during winter. Still others may experience stress associated with the holidays which worsen symptoms of SAD.
Seasonal Affective Disorder is felt to affect approximately 0.5-3 percent of the general population. In individuals already diagnosed with depression, a worsening of symptoms during fall/winter may occur. Additionally, for individuals with Bipolar Syndrome, a condition associated with severe depression and intermittent episodes of mania (psychosis with excessive emotional response), the seasonal effect on symptoms rises to 25% percent. Some may also be diagnosed with subsyndromal seasonal affective disorder, a condition of mild changes in mood that does not reach the level of a disorder. However, such individuals may benefit from some of the interventions shown to improve symptoms of SAD.
Treatment of SAD is aimed at reducing symptoms and improving functionality. There are three well accepted treatments for those affected. The primary treatment for SAD is Light Therapy. Light Therapy has been commonly used since the 1980s. It is administered daily by a very bright light box every day, usually in the morning, for approximately forty-five minutes. The light box is designed to filter out damaging UV rays, so the therapy is “skin safe,” while emitting light twenty times brighter than common indoor lighting. Cognitive Behavioral Therapy (CBT) has also been employed to combat symptoms of SAD. The focus of CBT in this setting is to replace negative thoughts about the winter months with more positive ones and the use of purposeful engagement in enjoyable indoor activities to elevate the mood. Finally, in some individuals, treatment with a certain medication called Selective Serotonin Reuptake Inhibitors (SSRI’s) may help to address the inactivity of serotonin. An additional medication called Bupropion (Wellbutrin) has also been shown to improve symptoms by increasing dopamine levels in individuals with SAD when taken during the fall/winter months.
TALK WITH A PHYSICIAN
As with all mental health disorders, a combination of one or more of the above treatments may be necessary to address symptoms. It is important to discuss your concerns with your physician to ensure you are receiving the most appropriate treatment. Additionally, it is not uncommon to see mental health disorders occur together. As mentioned previously, Seasonal Affective Disorder may present in conjunction with Major Depression Disorder, Generalized Anxiety Disorder, or Bipolar Disorder. Unfortunately, Seasonal Affective Disorder may also be associated with an increased risk for suicidal thoughts and attempts, so it is vitally important to encourage loved ones experiencing symptoms of SAD to discuss them with their physician. Your conversation can ensure symptoms are addressed and do not progress to harmful actions.
Kendall Wagner, M.D. is a regular healthcare contributor to Do South® Magazine.
Chaffee Crossing Clinic
11300 Roberts Boulevard, Fort Smith, Arkansas