S.A.D. is a mood-based disorder caused by the change of seasons. It is also known as the ‘winter blues’, since it primarily occurs during winter.
As the acronym suggests, S.A.D., or Seasonal Affective Disorder, is a mood-based disorder caused by the change of seasons. It is a type of depression that comes and goes with the seasons. It is also known as having the ‘winter blues’, as it primarily occurs during the winter months, but S.A.D. associated with summer and spring also exist. S.A.D. usually commences by the end of fall and beginning of winter.
Sunlight is not only important for vitamin D levels in our body, but also in regulating serotonin, a neurotransmitter responsible for feeling happy. During winter, as the days start becoming shorter, the amount of sunlight received by the body decreases. A protein called SERT that is responsible for serotonin levels increases by 5% in winter. SERT and serotonin have an inversely proportional relationship. As SERT increases, the amount of serotonin released in the body decreases. This results in depression, as serotonin is the neurotransmitter that makes us feel good.
Another indirect cause of this disorder are the melatonin levels in the body. Secreted by the pineal gland in the brain, melatonin is a hormone that causes sleepiness by responding to darkness. In winter, since there is less light, melatonin increases, resulting in us feeling more sluggish and lethargic. Lethargy is a common symptom of depression. Melatonin aids in the symptoms of depression and is therefore an indirect cause of S.A.D.
Decreased serotonin and increased melatonin affect the natural body clock of those who suffer from this condition. People with S.A.D. have a disturbed body clock or circadian rhythms, making it difficult for their bodies to adjust to the change of seasons.
How is S.A.D. diagnosed?
According to the DSM-V, which is a diagnostic and statistical manual of mental disorders, periods of depressive episodes should coincide with seasonal changes for at least a period of two years to be considered for a formal S.A.S. diagnosis. Symptoms of S.A.D. are very similar to symptoms of depression, including low moods, frequent crying, disinterest in activities, drastic weight gain or weight loss, withdrawal from social life, insomnia or hypersomnia.
Irritability is another common symptom, but this can also gradually progress to aggressive behavior and violence. Thoughts of self-harm or suicide can also be present in the case of severe depression and anyone experiencing these symptoms should be evaluated by mental health professionals.
There is a questionnaire specially designed by Rosenthal to screen for S.A.D. called SPAQ (Seasonal Pattern Assessment Questionnaire). It is user-friendly and freely available to be self-administered (The link can be found in the references).
People living away from the Equator are more prone to S.A.D. than people living in equatorial regions. Countries like Canada, the United States (Alaska) and the United Kingdom are more prone to season-related depression than tropical countries.
There are also gender differences when it comes to season-related depression. Women are four times more likely to suffer than men. Younger adults are more likely to be affected than older adults. The age of onset is 18 to 30 years in both genders. Like any other mental disorder, S.A.D. also co-occurs with other mood disorders, such as Bipolar disorder, anxiety, depression or attention deficit and eating disorders. People with a family history of mood disorders are more susceptible to S.A.D.
Treatment options for S.A.D
Wondering how to beat the winter blues? Well, medication along with counseling, light therapy and monitoring vitamin D levels are known treatment options for S.A.D. These methods can be used alone or in combination.
Since S.A.D. is a type of depression, antidepressants can be used to treat this mood disorder. SSRI (Selective Serotonin Re-uptake Inhibitor) and SGAs (Second Generation Antidepressants) are the two types of antidepressants used for this treatment. An SGA sold under the brand name ‘Bupropion’ is one of the most common antidepressants. Antidepressants are not available over the counter and a psychiatrist’s prescription is mandatory. Antidepressants also come with a lot of side effects and your reaction to the drug must be continuously monitored by a mental health professional. Since S.A.D. patients have low vitamin D levels due to low sunlight exposure,vitamin D supplements can also aid in treating the symptoms.
Medications are not the only solution for treating S.A.D., as depression is a psychosomatic disorder. A psychosomatic disorder means that the mind, as well as the ‘soma’ (body) are responsible for the condition. Cognitive Behavioral Therapy (CBT) is the most popular therapy, as it treats thoughts (cognition) as well as behavior. CBT can be conducted by any psychologist or psychiatrist who specializes in counseling. Medication in conjunction with therapy is one of the best methods to treat S.A.D.
The little things that we do every day go a long way in determining our happiness levels. A healthy diet rich in proteins, vegetables, complex carbs and a minimal amount of unprocessed food should be added. Sugar and starch should be consumed in limited quantities. Mindfulness exercises like Transcendental Meditation, yoga, walking outside, and being around nature should be a part of one’s daily routine.
Light therapy involves substituting natural light deficiency with artificial light boxes. Light boxes emit full spectrum light, which is similar to natural sunlight. Typically devoting 20-60 minutes under the exposure of such lights fills up a person’s natural sunlight deficiency. Typically cold countries, especially Scandinavian countries, have light rooms available for citizens. The adverse effects of light therapy are much fewer in comparison to antidepressants. They include headaches, irritability and hypomania. Light therapy cannot be coupled with photosensitizing medications and certain antibiotics.
No one likes to be depressed, but recognizing one’s patterns can help prevent depressive episodes. Before winter approaches, necessary preventive measures should be taken, such as increasing light exposure, lifestyle changes and medications, if needed. If medications are started earlier, the blow of S.A.D. will not be as strong come winter. The silver lining to this story is that S.A.D is very treatable, although not something that may ever be fully “cured”.