No one likes to see summer end, but for some people, the shortening of daylight and increase in stormy weather triggers a form of depression, otherwise known as Seasonal Affective Disorder.
What is seasonal affective disorder (SAD)?
Seasonal affective disorder is also known as winter depression, winter blues or seasonal depression. It is a mood disorder in which people who have normal mental health throughout most of the year experience symptoms of depression as fall and winter approach. (A spring/summer version can also occur, but this is rare.)
What triggers SAD?
It is believed that less daylight during the fall and winter can cause depression in some people. Other factors contributing to SAD may include genetics, age and chemical imbalance. Neurochemicals help regulate our mood and ability to function. Melatonin is a hormone that our brains produce during the hours of darkness. It helps regulate sleep, body temperature and the release of hormones. As with any hormone, the amount produced is important. People with SAD produce too much melatonin. This excess throws off their internal body clock leading to symptoms of depression. If you have had episodes of depression that clearly have an onset in fall or winter followed by remission of symptoms in the spring or summer, you may have SAD.
What are symptoms of SAD?
Symptoms include:
- Depressed mood
- Irritability
- Hopelessness
- Anxiety
- Loss of energy
- Social withdrawal
- Oversleeping (feeling like you want to hibernate)
- Loss of interest in activities you normally enjoy
- Appetite changes, especially a craving for foods high in carbohydrates such as pastas, rice, bread and cereal
- Weight gain
- Difficulty concentrating and processing information
How is SAD treated?
There are a number of options. Medications or light therapy (phototherapy) are usually the first step.
Light Therapy
Light therapy literally involves using exposure to light as a way of sending new signals to the brain and lifting depression. The type of light used, the patient’s distance from the light, and the amount of time spent in front of the light, are very specific. The light should be of adequate intensity, 10,000 lux (lux is a measurement of light intensity) is usually recommended. At 10,000 lux, the amount of time required in front of the light is 30 minutes per day. If the light is 5,000 lux, then the amount of time will be 60 minutes per day. The person undergoing treatment needs to have their eyes open so that the light reaches the retina in the back of the eye. The patient does not need to look directly at the light, and can read, do crosswords, knit, etc. while undergoing treatment. Patients usually sit about 12 to 18 inches away from the light. The light does not emit damaging UV rays, but some people have complained of eye strain or headaches. Light therapy is typically done in the morning, as it can cause insomnia if done too late in the day. If you struggle with bipolar, hypomanic or manic episodes, these can be triggered by light therapy, so light therapy should be used with extreme caution in these cases.
You can purchase a phototherapy light without a prescription, but speak with your provider first to discuss the best type to buy and how it should be used. Some insurance companies may cover some of the cost.
Patients with milder forms of SAD have experienced light therapy by simply increasing their exposure to sunlight–sitting by a window, spending more time outside, for example.
Medication
Antidepressants have proven effective in treating SAD. Sometimes these are used in combination with light therapy. Increasing Vitamin D levels has also had some success. Your doctor can advise after a thorough review of your symptoms.
Other Treatments
Behavioral changes and finding the right social support can also be effective. People experiencing SAD have benefited from:
- Counseling to help them identify signs of depression and ways to cope with negative thoughts
- Stress management
- Joining weight control/nutrition groups for adjustments to their diets that will enhance energy levels
- Counseling to help them improve their social skills and networking and thus increase their interaction with others
- Finding wintertime activities that they enjoy
- Education on sleep management.
- If the coming of winter makes you feel blue, do not suffer in silence. Make an appointment with a mental health provider and get the treatment you need to make every season of the year one to enjoy.
Know the Signs
How do you know if you or a loved one is being affected by depression?
The classic symptoms include a persistently sad mood, irritability, an inability to enjoy activities that are usually a source of pleasure, fatigue, lack of energy, poor sleep (or increased sleep), guilt, excessive worrying, and a decline in what doctors call cognitive functioning– meaning memory, concentration, decision-making, and thinking clearly. A decline in sex drive, appetite, and interest in social interaction can also occur. Sometimes thoughts of suicide are also present, and this is obviously of significant concern.
If you, or a loved one, have a combination of these symptoms, a psychiatric evaluation is recommended.
What Happens During a Psychiatric Evaluation?
A psychiatric evaluation consists of a thorough review of a person’s history. The psychiatrist will ask about the current episode of depression and when those feelings began, as well as explore possible past episodes. Further areas of exploration include past psychiatric history, family psychiatric history, substance abuse history, trauma history, medical history, social history, and educational history (particularly important with children and adolescents). Stress factors that may be contributing to the depression are reviewed. Symptoms need to be clearly defined so they can be targeted and treated. We make sure to clearly identify the target areas so we can measure improvement.
Types of Treatment
Treatment for depression can take several forms. A number of types of psychotherapy can be used. Psychotherapy is a way of healing a mental disorder by psychological rather then medical means. I will provide referrals for psychotherapy if it is indicated and the patient does not presently have a therapist. As a psychiatrist (who is a medical doctor and can prescribe medications), I feel it is extremely important for anyone suffering from depression to become aware of the medication options that may be useful for treatment. I discuss these options thoroughly with my patients, including their pros and cons, along with the option for psychotherapy. This way, patients, or their family members, can make informed decisions as to what course of treatment may work best. Sometimes the choice is medication, sometimes therapy, and sometimes a combination is used. 
