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Seasonal Affective Disorder (SAD): Tips for Fighting the Winter Blues

Teresa Tanoos's picture
Research shows bright light therapy and antidepressants work best in fighting SAD.

If you’re sad this time of year, you’re not alone, and there may be more to it than just a case of the so-called “holiday blues”. Although there are many people who associate the holidays with happy memories, good times and cheer, there are those who feel just the opposite due to a condition called Seasonal Affective Disorder, or SAD for short.

Indeed, some 500,000 people in the United States are diagnosed each year with SAD, which is a type of depression that occurs during certain seasons of the year, especially in winter when the days are colder, shorter and darker due to less sunlight.

An additional 10 to 20 percent of the American population suffers from a less severe form of SAD, and then there are those who go undiagnosed, making it difficult to determine precisely how many people suffer from the disorder.

Typically, a person has SAD symptoms anywhere from 2 to 3 years before being diagnosed with this particular type of seasonal depression, which was first identified in 1985 by Dr. Normal Rosenthal, and is also known as Seasonal Adjustment Disorder.

Despite the prevalence of people suffering SAD around the globe, experts are concerned that many physicians are still not educated about the disorder, which could result in more people suffering from SAD not being properly diagnosed.

Symptoms of SAD

It’s therefore important for those who are feeling down this time of year to be aware of the symptoms of SAD, which the American Psychiatric Association (APA) identifies as follows:

• Fatigue
• Lack of interest in normal activities
• Social withdrawal
• Craving foods high in carbohydrates
• Weight gain

According to the APA, depressive symptoms of SAD can be mild to moderate, but they can become severe. People who work long hours inside office buildings with few windows are especially at risk for suffering symptoms of SAD year-round.

Depression from SAD can come on slowly or suddenly. For the majority of SAD sufferers, symptoms hit them as early as autumn, when the weather gets colder and the days get shorter. Their symptoms then begin to go away as winter gives way to spring, and then they stay away through the duration of summer.

Seasonal Affective Disorder can strike people at any age, but more often than not, the onset of SAD commonly starts before age 21, and women are twice as likely to develop SAD than men.

Like regular depression, symptoms of SAD include changes in mood, as well as heightened anxiety and panic attacks.

Other symptoms of SAD

Other symptoms of SAD include a lack of motivation or an inability to carry out daily tasks, a lack of interest in things previously enjoyed, sleep problems, overeating, alcohol and/or drug abuse, decreased sex drive, feeling irritable, inability to concentrate, relationship problems and not feeling sociable.

What causes SAD?

Previous studies suggest that SAD is due to the change in seasons that affect the amount of sunlight we receive, but the precise mechanism that prompts the onset of the disorder remains unknown.

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Others speculate that SAD is triggered by the change in light that occurs when seasons shift because when light shines into the eye’s retina, it activates the hypothalamus, the region of the brain where mood, appetite, sex drive and sleep are controlled. Therefore, a lack of light would theoretically cause these bodily functions to slow down and eventually cease working.

Another theory for what triggers SAD has to do with serotonin levels. Serotonin is a neurotransmitter in the brain, and people with depression have been found to have lower levels of it, especially in the winter time.

Accordingly, it has been suggested that those who suffer from SAD could have a lack of serotonin in their brain or some other problem that disrupts the release and absorption of serotonin in the brain.

There’s also evidence that those suffering from SAD have more of the hormone melatonin in their bodies during the darker months of winter than those who don’t have SAD. However, research into this has not been conclusive, as other studies show that the chance of melatonin being the sole cause of SAD is highly improbable.

Nevertheless, melatonin does appear to be a factor that contributes to SAD.

Melatonin is manufactured by the pineal gland, which is located in the brain. When day turns to night and we’re exposed to darkness, the pineal gland cranks out melatonin, which puts us to sleep. When night gives way to the dawn of morning with the light shining again, the pineal gland stops making melatonin, which causes us to wake up.

In people with SAD, however, the role of melatonin does not work the same, as they still feel depressed even after their melatonin levels return to normal when they wake up from a night of sleep.

This raises yet another theory that SAD is caused by faulty wiring that disrupts the settings of the body’s circadian rhythm, or body clock; thus, interfering with the body’s ability to adjust to daylight hours and causing symptoms of fatigue and depression as a result.

The good news about SAD

Thankfully, there are many ways to successfully treat SAD, including a combination of bright light therapy, antidepressants, counseling and/or Cognitive Behavior Therapy (CBT) to achieve maximally effective results.

However, when starting most antidepressants, patients must be patient because it usually takes 4 to 6 weeks for the antidepressant effect to kick in, not to mention that the first antidepressant may not work, so the patient may have to go through a process of “trial and error” before finding the right combination of drugs that are effective for them.

Meanwhile, bright light treatment may be tried alone if the patient is resistant to taking antidepressants, as research has found bright light therapy works up to 85 percent of the time to significantly reduce the symptoms of SAD.

There are many companies that sell bright light therapy machines, which typically look like a square box that exposes simulated outdoor light to a person’s face for around 2 hours each day. The simulated light is at least 10 times the intensity of standard indoor lighting and can be purchased online from a variety of manufacturers on the Internet.

The bright light therapy boxes are believed to work by regulating neurotransmitters in the brain that elevate mood and therefore relieve the symptoms of SAD.

However, research shows that using a combination of light therapy and antidepressants is the most effective treatment for SAD, especially when counseling or talk therapy is used in conjunction to help SAD patients learn to cope with their depression symptoms.

Avoiding stressful situations when you have SAD also helps, as does implementing a healthy diet and regular exercise program that is preferably performed where there’s as much natural light as possible.

SOURCES: American Psychiatric Association, Seasonal Affective Disorder; National Alliance on Mental Illness, What is seasonal affective disorder (SAD)?, Ken Duckworth, M.D., and Jacob L. Freedman, M.D. (December 2012).