WHAT IS SEASONAL AFFECTIVE DISORDER (SAD)
Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons — SAD begins and ends at about the same times every year. If you’re like most people with SAD, your symptoms start in the fall and continue into the winter months, zapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer.
Treatment for SAD may include light therapy (phototherapy), psychotherapy and medications.
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.
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. However, some 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.
Seasonal affective disorder is a subtype of major depression that comes and goes based on seasons. So symptoms of major depression may be part of SAD, such as:
•Feeling depressed most of the day, nearly every day
•Feeling hopeless or worthless
•Having low energy
•Losing interest in activities you once enjoyed
•Having problems with sleeping
•Experiencing changes in your appetite or weight
•Feeling sluggish or agitated
•Having difficulty concentrating
•Having frequent thoughts of death or suicide
Fall and winter SAD
Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:
•Tiredness or low energy
•Problems getting along with other people
•Hypersensitivity to rejection
•Heavy, “leaden” feeling in the arms or legs
•Appetite changes, especially a craving for foods high in carbohydrates
Spring and summer SAD
Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include:
•Trouble sleeping (insomnia)
•Agitation or anxiety
Seasonal changes in bipolar disorder
In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression.
When to see a doctor
It’s normal to have some days when you feel down. But if you feel down for days at a time and you can’t get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or turn to alcohol for comfort or relaxation.
The specific cause of 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.
pic via OSA
Factors that may increase your risk of seasonal affective disorder include:
•Being female. SAD is diagnosed more often in women than in men, but men may have more-severe symptoms.
•Age. Young people have a higher risk of winter SAD, and winter SAD is less likely to occur in older adults.
•Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.
•Having clinical 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.
Take 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:
•Suicidal thoughts or behavior
•School or work problems
Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad.
Preparing for your appointment
You’re likely to start by seeing your family doctor or primary care provider. Or you may start by seeing a mental health provider such as a psychiatrist or psychologist.
Here’s some information to help you get ready for your appointment.
What you can do
Before your appointment, make a list of:
•Your symptoms, such as feeling down or having a lack of energy
•Your depression patterns, such as when your depression starts and what seems to make it better or worse
•Any other mental or physical health problems you have — both can affect mood
•Any major stressors or life changes you’ve had recently
•All medications, vitamins or supplements you’re taking, including dosages
•Questions to ask your doctor, in order of priority
For seasonal affective disorder, some basic questions to ask include:
•Are my symptoms likely caused by SAD, or could they be due to something else?
•What else could be causing or worsening my symptoms of depression?
•What are the best treatment options?
•Are there any restrictions that I need to follow or steps I should take to help improve my mood?
•Should I see a psychiatrist, psychologist or other mental health provider?
•Are medications likely to improve my symptoms?
•Is there a generic alternative to the medication you’re prescribing me?
•Are there any brochures or other printed material that I can have? What websites do you recommend?
Don’t hesitate to ask questions anytime during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:
•What are your symptoms?
•When did you first begin having symptoms?
•Have your symptoms been continuous or occasional?
•How severe are your symptoms?
•What, if anything, seems to improve your symptoms?
•What, if anything, appears to worsen your symptoms?
•Do you have any other physical or mental health conditions?
•Are you taking any medications, supplements or herbal remedies?
•Do you use alcohol or drugs?
•Do any of your blood relatives have SAD or another mental health condition?
Tests and diagnosis
To help diagnose seasonal affective disorder, your doctor or mental health provider 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 provider asks about your symptoms, thoughts, feelings and behavior patterns. Your doctor may have you fill out a questionnaire to help answer these questions.
Seasonal affective disorder is considered a subtype of major depression or bipolar disorder. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health provider to diagnose SAD because other types of depression or other mental health conditions can cause similar symptoms.
Many mental health professionals use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment.
The DSM-5 criteria for diagnosing depression with a seasonal pattern includes having these experiences for at least the last two years:
•Depression that begins during a specific season every year
•Depression that ends during a specific season every year
•No episodes of depression during the season in which you experience a normal mood
•Many more seasons of depression than seasons without depression over the lifetime of your illness
In our Part 2 we’ll get into Treatments & Drugs, and alternative resources.
Featured Image via WSCU