Seasonal Affective Disorder Is Real and Very Treatable

Everyone reacts differently to the approach of fall and winter. Some people love the colder weather and look forward to winter sports, cozy nights in front of the fire and holiday festivities. Others may prefer the spring and summer months but don’t have a strong reaction to the change of seasons.

But for up to half a million Americans each year, they experience strong physical and psychological symptoms as the days get shorter in the transition from summer to fall. If their symptoms re-occur every year at the same time, they might be diagnosed with seasonal affective disorder (SAD).

SAD Is a Recognized Diagnosis

“SAD is a real medical condition and a subtype of depression which has specific criteria for diagnosis and effective treatment,” says Francoise Adan, MD, psychiatrist and Chief Whole Health and Well-Being Officer at University Hospitals. “Unlike a passing case of the winter blues, symptoms usually begin in September or October, persist throughout the winter months and disappear in March or April, when the days get longer again,” she adds.

The symptoms of SAD typically include:

• Feeling sluggish and slow in mind and body
• Increased sleep and difficulty getting up and moving in the morning
• Cravings for carbs and other comfort foods, often resulting in weight gain
• Loss of interest in activities normally enjoyed

“If you have SAD, you know it,” says Dr. Adan. “It feels like walking with a heavy pack on your back. People with SAD can be seriously impaired both functionally and emotionally.”

What Causes SAD?

Researchers don’t fully understand what causes seasonal depression, but most agree it is associated with the shorter days, longer periods of darkness and reduced exposure to sunlight that comes with the onset of fall and winter.

“Reduced sunlight disrupts the internal clock that lets us know when to sleep and when to be active,” says Dr. Adan. “When it is bright and sunny outside the brain releases a chemical called serotonin which is believed to help boost mood, promote calmness and increase focus. Similarly, darkness triggers the release of melatonin, a chemical that makes us feel sleepy. Some people are very sensitive to the reduced serotonin levels that can occur with less exposure to sunlight and their circadian rhythm can be significantly deregulated, leaving them feeling out of sorts and off-balance emotionally.”

Who Is at Increased Risk?

The farther away from the equator you live, the higher your risk for SAD – likely because of the decreased exposure to sunlight during the winter. Therefore, people living in far northern or southern parts of the world are more susceptible. Other risk factors include:

• Gender: Women are more frequently diagnosed but men often have more severe symptoms.
• Family history: SAD is more common in people with blood relatives with SAD or another type of depression.
• Personal medical history: Those with a history of depression or bipolar disorder may be more likely to develop SAD.
• Vitamin D deficiency: Low levels of Vitamin D can be a risk factor for SAD.

When to Seek Treatment for Seasonal Depression

It is important to be self-aware and pay attention to how you are feeling as winter approaches. If you notice a decline in your mood that persists for days, your sleep and appetite patterns have changed and you have trouble getting motivated to do activities you normally enjoy, or if you feel hopeless and are considering self-harm, it is important to see your healthcare provider.

The first thing your doctor will do is rule out other potential causes of your symptoms such as viral infections, hypothyroidism or other medical conditions. “It can be scary to all of a sudden have feelings of being nonfunctional. Knowing that your symptoms aren’t life-threatening and that you have a real and treatable condition is reassuring,” says Dr. Adan.

If a diagnosis of SAD is confirmed, beginning treatment is essential. Without intervention, SAD symptoms will usually persist and worsen throughout the winter months, often becoming debilitating.

Effective Treatments Are Available

The first line of treatment for SAD is light therapy (phototherapy), which is inexpensive and convenient as it can be done at home.

Light therapy involves the use of a light box which produces bright artificial light that the patient simply looks at every morning, initially for 15 minutes and gradually increasing to 30 minutes. “For this treatment to be effective, the light box must be consistently used every day starting as soon as the symptoms begin and continuing through March and April,” says Dr. Adan. “And, it’s very important to ensure that the light box used produces 10,000 lux (a measurement of light level intensity) or it won’t be effective,” she emphasizes.

Light boxes are readily available online and in select retail stores – a prescription is not required.

Light therapy is often the only treatment needed to resolve symptoms. Some patients, however, may benefit from additional treatments which may include:

• Cognitive Behavioral Therapy: Talking to a mental health professional can be beneficial for some people.
• Medication: Some patients may need the additional, temporary support of antidepressant medication.
• Integrative Medicine: There is some evidence that acupuncture, yoga and meditation and some supplements can be helpful for some people.

“In addition, patients should follow healthy lifestyle practices such as getting outside, even on cold days; exercising regularly; and taking steps to make their environment sunnier and brighter, such as opening the blinds to allow the light in,” says Dr. Adan.

Additional Ways to Manage or Prevent SAD

Even though some people may be biologically predisposed to developing seasonal affective disorder, there are steps everyone can take to lower their risk. These include:

• If you know you have SAD, begin light therapy in September before the onset of symptoms
• Eat a healthy diet rich in fruits, vegetables, whole grains and lean protein
• Eliminate or minimize alcohol use
• Maintain regular sleep patterns

Related Links

Symptoms of depression should never be ignored. University Hospitals has a wide network of primary care physicians and behavioral health professionals at convenient locations across the region who can diagnose and treat all types of depression, including seasonal affective disorder.