SAD: Season Affective Disorder

Seasonal affective disorder (SAD) Is a mood disorder subset in which people who have normal mental health throughout most of the year exhibit depressive symptoms at the same time each year, most commonly in winter. Common symptoms include sleeping too much, having little to no energy, and overeating. The condition in the summer can include heightened anxiety.

SAD is said to occur due to changes in the body’s internal clock, and changes in the brain and body’s chemicals. Feeling depressed on most days, feelings of hopelessness and worthlessness, reduced energy, concentration, and interest in activities are the commonly noted symptoms. Light therapy, medications, and psychotherapy are the treatments available for SAD.

Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

Symptoms

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.

Signs and symptoms of SAD may include:

• Feeling depressed most of the day, nearly every day
• Losing interest in activities you once enjoyed
• Having low energy
• Having problems with sleeping
• Experiencing changes in your appetite or weight
• Feeling sluggish or agitated
• Having difficulty concentrating
• Feeling hopeless, worthless, or guilty
• Having frequent thoughts of death or suicide

Fall and winter SAD

Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:

• Oversleeping
• Appetite changes, especially a craving for foods high in carbohydrates
• Weight gain
• Tiredness or low energy

Causes

The specific cause of the seasonal affective disorder remains unknown. Some factors that may come into play include:

• Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body’s internal clock and
  lead to feelings of depression.
• Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger
  depression.
• Melatonin levels. The change in season can disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood.

While we don’t know the exact causes of SAD, some scientists think that certain hormones made deep in the brain
trigger attitude-related changes at certain times of the year. Experts believe that SAD may be related to these hormonal changes. One theory is that less sunlight during fall and winter leads to the brain making less serotonin, a chemical linked to brain pathways that regulate mood. When nerve cell pathways in the brain that regulate mood don’t function normally, the result can be feelings of depression, along with symptoms of fatigue and weight gain.

SAD usually starts in young adulthood and is more common in women than men. Some people with SAD have mild symptoms and feel out of sorts or irritable. Others have worse symptoms that interfere with relationships and work. Because the lack of enough daylight during wintertime is related to SAD, it’s less often found in countries where there’s plenty of sunshine year-round.

Risk factors

Seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more
frequently in younger adults than in older adults.

Factors that may increase your risk of seasonal affective disorder include:

• Family history. People with SAD may be more likely to have blood relatives with SAD or other forms of depression.
• Having major depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.
• Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.

Complications

Take the signs and symptoms of seasonal affective disorder seriously. As with other types of depression, SAD can get worse and lead to problems if it’s not treated.

These can include:

• Social withdrawal
• School or work problems
• Substance abuse
• Other mental health disorders such as anxiety or eating disorders
• Suicidal thoughts or behavior

Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad.

Diagnosis

Even with a thorough evaluation, it can sometimes be difficult for your doctor or professional to diagnose seasonal affective disorder because other types of depression or other mental health conditions can cause similar symptoms.

To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes:

• Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it’s functioning properly.
• Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings, and behavior patterns. You may fill out a questionnaire to help answer these questions.
• DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the
  American Psychiatric Association.

Treatment

Treatment for seasonal affective disorder may include light therapy, medications, and psychotherapy. If
you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Light therapy

In light therapy, also called phototherapy, you sit a few feet from a special lightbox so that you’re
exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

Light therapy is one of the first-line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes few side effects. Research on light therapy is limited, but it appears to
be effective for most people in relieving SAD symptoms.

Before you purchase a light box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that’s safe and
effective. Also, ask your doctor about how and when to use the lightbox.

Medications

Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.

An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD.

Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice the full benefits of an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the
fewest side effects.

Psychotherapy

Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known
as cognitive behavioral therapy can help you:

• Identify and change negative thoughts and behaviors that may be making you feel worse
• Learn healthy ways to cope with SAD, especially by reducing avoidance behavior and scheduling activities
• Learn how to manage stress

Mind-body connection

Examples of mind-body techniques that some people may choose to try to help cope with SAD include:

• Relaxation techniques such as yoga or tai chi
• Meditation
• Guided imagery
• Music or art therapy

Lifestyle and home remedies

In addition to your treatment plan for seasonal affective disorder:

• Make your environment sunnier and brighter.
  Open blinds, trim tree branches that block sunlight, or add skylights to your home. Sit closer to bright windows while at home or in the office.
• Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.
• Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being fitter can make you feel better about
  yourself, too, which can lift your mood.

Alternative medicine

Certain herbal remedies, supplements, or mind-body techniques are sometimes used to try to relieve depression symptoms, though it’s not clear how effective these treatments are for seasonal affective disorder.

Herbal remedies and dietary supplements aren’t monitored by the Food and Drug Administration (FDA) the same way medications are, so you can’t always be certain of what you’re getting and whether it’s safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your doctor or pharmacist before taking any supplements.

Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. When it comes to depression, alternative treatments aren’t a substitute for medical care.

Seasonal Affective Disorder Statistics

1. Estimated to affect 10 million Americans every year.
2. While an extra 10-20% may have mild episodes.
3. It is much more common in women than men.
4. Typically starts around age 20.
5. Some people’s symptoms affect their quality of life.
6. 6% have required hospitalization.
7. 55% percent of people have family members with a depression issue.
8. 34% have family members with alcohol abuse.
9. Normally doesn’t happen in children under 20 years old.
10. Sometimes detected by parents and teachers.
11. Risk decreases the older you get.
12. More common in the northern states.

Coping and support

These steps can help you manage seasonal affective disorder:

• Stick to your treatment plan. Follow your treatment plan and attend therapy appointments when scheduled.
• Take care of yourself. Get enough sleep to help you feel rested, but be careful not to get too much rest, as SAD symptoms often lead people to feel like hibernating. Participate in an exercise program or engage in another form of regular physical activity. Make healthy choices for meals and snacks. Don’t turn to alcohol or recreational drugs for relief.
• Practice stress management. Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
• Socialize. When you’re feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on, or shared laughter
  to give you a little boost.
• Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter SAD or cooler locations if you have summer SAD.

Herbal Natural Remedies

St. John’s Wort Extract

St. John’s Wort is one of the most commonly recommended herbs for relief from feelings of depression, anxiety, or nervousness. Contributor Kim Erickson advised that recent studies have shown that St. John’s wort is just as effective for the treatment of mild to moderate depression as prescription SSRIs, the only exception being that the herb has far fewer side effects. While doctors warn that the herb can make some prescription medications less effective when taken in combination with birth control pills, for example, the possible side effects are much less serious and extensive than those of prescription antidepressants.

When taking St. John’s Wort, your skin becomes more susceptible to UV rays so you should always wear sunscreen when heading outside. The standard daily dosage for mild to moderate depression is 500 to 1,000 mg of St. John’s Wort extract, which you can find at your local drugstore. The effects of this herb are not immediate, so you should continue taking it for at least 3 to 4 weeks before deciding if it’s right for you.

Essential Oils for Depression

As an alternative to consuming herbal extracts, you can also reap their benefits through aromatherapy with a variety of essential oils. In aromatherapy, essential oils are generally absorbed into the
circulatory system through the skin or mucous membranes. The primary aromatherapy methods include inhalation, vaporization, bathing, massage, and spray. Aromatherapy can be as simple as adding a few drops of your chosen essential oil to a hot bath. You can also mix one teaspoon of oil with seven ounces of distilled water and one ounce of 90 percent isopropyl alcohol to create a spray, which can be applied to linens or bedding for a soothing effect.

• Ylang-ylang essential oil is often used to treat feelings of sadness and anxiety. According to ylang ylang essential oil is used to lower high blood pressure and dispel depression as it creates a sense of euphoria with its sweet, calming scent.

• Lavender oil contains chemicals, which exert a sedative, calming effect. This essential oil is especially effective when used in a hot aromatherapy bath to soothe the soul and calm nerves.

• Chamomile is an expensive essential oil, but it is effective in relieving increased levels of anxiety and tension.

Passionflower for Anxiety

Passionflower is effective in treating nervous agitation, anxiety, and mild insomnia. Passionflower is thought to work by increasing levels of gamma-aminobutyric acid in the
brain, resulting in a calming feeling. Passionflower is often combined with sedative herbs like valerian, skullcap, or lemon balm to create a sense of total relaxation.

The alkaloids and flavonoids in this herb create a feeling of overall well-being by sedating the nervous system. Most commonly consumed as a tea, passionflower tinctures, and extracts can be purchased at your local health-food store. Passionflower leaves should not be taken in combination with antidepressant drugs known as monoamine oxidase inhibitors (MAOIs) because the herb contains alkaloids, which reduce the effects of this class of medication.

You should always consult your health-care provider before using any of these herbs, in case of possible drug interactions.

Thank you for reading

Michael

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