What is Seasonal Affective Disorder?
During the fall and winter months, some people suffer from symptoms of depression that can appear gradually or come on all at once. The symptoms often dissipate as spring arrives and stay in remission through the summer months. For some people, this is a sign that they suffer from Seasonal Affective Disorder (SAD).
What Are The Symptoms?
Symptoms usually appear during the colder months of fall and winter, when there is less exposure to sunlight during the day. Depression symptoms can be mild to moderate, but they can become severe. Those who work long hours inside office buildings with few windows may experience symptoms all year, and some individuals may note changes in mood during long stretches of cloudy weather. Symptoms can include, but are not limited to:
- Low mood
- Fatigue and lack of energy
- Sleeping more
- Lack of interest in normal activities
- Social isolation or withdrawal
- Craving foods high in carbohydrates
- Weight gain
What If I Have Only Some of the Symptoms or Even Opposite Ones?
Those with SAD may not experience every symptom. For example, energy level may be normal while carbohydrate craving may be extreme. Sometimes a symptom is opposite the norm, such as weight loss as opposed to weight gain. In a small number of cases, annual relapse occurs in the summer instead of the fall and winter, possibly in response to high heat and humidity. In these cases, the depression is more likely to be characterized by insomnia, decreased appetite, weight loss, and agitation or anxiety.
How Does SAD Develop?
SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and the lack of sunlight in winter. Just as sunlight affects the seasonal activities of animals, SAD may be an effect of this seasonal light variation in humans. As seasons change, people experience a shift in their biological internal clock, or circadian rhythm, that can cause them to be out of step with their daily schedule.
How Is Biochemistry Involved?
Melatonin, a sleep promoting hormone, also has been associated with SAD. This hormone, which has been linked to depression, is produced at increased levels in the dark. When the days are shorter and darker, more melatonin is produced. Researchers have shown that bright light makes a difference to the brain chemistry by decreasing melatonin production. Some evidence suggests that the further someone moves from the equator, the more likely they are to develop SAD. The most difficult months for SAD sufferers seem to be January and February. SAD may begin at any age, but the main age of onset is between 18 and 30 years of age.
Is Treatment Available?
Increased exposure to sunlight can improve symptoms of SAD. This can be a long walk outside or arranging your home or office so that you are exposed to a window during the day. If your depressive symptoms are severe enough to significantly affect your daily living, light therapy, or phototherapy, has proven to be an effective treatment option. Research has shown that bright light makes a difference to brain chemistry, although the mechanisms by which this occurs are not yet known.
What is Phototherapy?
Phototherapy involves using light therapy boxes which are also called bright light therapy boxes. A light box mimics outdoor light by using ultraviolet light. Researchers have shown that this type of light causes the same chemical changes in the brain as does natural light. Most people use light boxes for about 30 to 60 minutes each morning. All light boxes for SAD treatment are designed to do the same thing, but one may work better for you than another. They are available from stores and Internet retailers, come in different shapes and sizes and have various features. They also produce different types and intensities of light. Light boxes are designed to be safe and effective, but they are not approved or regulated by the Food and Drug Administration (FDA). Therefore, it is recommended that you consult with your doctor so that you can get a light therapy box that best suits your needs.
Are There Any Other Treatments Available?
Several studies have shown that light box therapy is effective on its own. However, for individuals with more severe depressive symptoms, light therapy may be combined with an antidepressant medication or psychological counseling (psychotherapy). The only antidepressant medication that has been approved by the FDA to treat SAD is buproprion (Wellbutrin).
How Do I Know If I Have SAD?
If you feel you are suffering from SAD, it is important to seek the help of a trained medical professional. SAD can be misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and several other viral infections. For some people, SAD may be confused with a more serious condition like severe depression or bipolar disorder. However, if you feel the depression is severe or if you are experiencing suicidal thoughts, consult your doctor immediately regarding treatment options or go to your closest emergency room for help. A mental health professional can diagnose the symptoms and suggest therapy options. With the right course of treatment, SAD can be a manageable condition.
Please feel free to post comments or questions below or you can reach out to our office at 919-636-5240.
Dr. Nicola Gray