It can come over you like a cold snap, when the outside takes on an icy stillness and colors seem to fade into gloomy grayscale. That’s how some people describe the onset of seasonal affective disorder—SAD for short—which is a form of major depression. SAD tends to kick in when seasons change, most typically during fall and winter.
A small number of people experience it during spring and summer. But for the purposes of this article, I’m focusing on the more common form.
Between six and 14 percent of Americans are said to suffer from either mild or moderate forms of SAD. Symptoms include:
- Feeling hopeless and worthless
- Losing interest in activities you normally enjoy
- Socially isolating
- Increased appetite
- Poor sleep
- Difficulty concentrating and making decisions
- Lack of energy (lethargy)
- Diminished sex drive
- Increased agitation
Some sufferers even experience suicidal thoughts.
These are serious symptoms, yet often people with this condition are dismissed as just having the “doldrums”, with well-meaning loved ones urging them to just “snap out” of it. Or, around the holidays, accusing them of being Scrooge-like (hey, maybe SAD was old Ebenezer’s problem!).
But SAD is no laughing matter. Many of its symptoms match those for regular major depressive disorder (MDD), with some important differences. One is that, while MDD can occur at any time, SAD tends to occur when temperatures get colder, the days shorter, and sunlight less intense (more about this in a bit).
Another difference concerns appetite. Persons with MDD typically eat less and lose weight as a result. But those with SAD often crave carbohydrates, eat more, and end up putting on weight.
At this point, let me add a word about the holidays. For a lot of us, that “magical” time between Thanksgiving and New Year’s becomes less magical and more bittersweet. Because as we get older, we might think back on holidays past and the loved ones who are no longer with us. This is normal, and the “sweet” part is that, along with feeling mild sadness, we will concurrently feel happy as we remember those good times.
Kind-a weird how bitter and sweet can show up at the same time around the holidays. But that doesn’t necessarily mean we have SAD. Because when you have SAD, it’s extremely hard, if not downright impossible, to access those sweet feelings.
The Scoop on SAD
So what causes SAD? Some studies suggest a genetic link, indicating a tendency for it to occur in families across generations. It can also be an exaggerated, primitive survival response to winter, a season when weather can be harsh and food less abundant. Some mammals hibernate to conserve energy; our human bodies just may be telling us to slow down. But for someone with SAD, “slowing down” can mean depression and lethargy.
The most prevalent theory these days, is that persons with SAD have an abnormal sensitivity to light. Which brings us to the term, zeitgeber (no, that’s not the name of a really hip, micro-brewed craft beer).
Zeitgebers are a form of stimuli that help to synchronize humans’ biological responses to day and night (aka, circadian rhythm). They prompt us to be active when there’s daylight and to sleep after the sun goes down. Light, either natural or synthetic, is a major zeitgeber.
Some researchers theorize that people with SAD require a stronger exposure to light. This is so they can reset their circadian rhythms and thus sleep better. And better sleep will then improve their moods and help them feel more energetic when awake. But as with many studies, further research is needed.
The culprit behind this need for more light appears to be the abnormal activation of melatonin, a hormone produced in the pineal gland that helps to regulate our sleep and wake cycles. Normally, melatonin secretes in the evening, which then makes us tired and eventually puts us to sleep. When we have SAD, however, the melatonin effect is delayed, and our sleep becomes more disturbed and less restorative. This ongoing lack of restorative sleep can cause one to feel run down and, well, blah.
Ahh… good old restorative sleep – the stuff dreams are made of!
Literally.
Restorative sleep is, as its name suggests, the state in which our bodies—including our brains—repair and restore themselves. It’s comprised of two stages, one being REM, or Rapid-Eye Movement sleep, in which dreaming occurs. The other stage is simply called deep sleep. There are other sleep stages as well, with fancy names I won’t bore you with. The point is that we need to have restorative sleep every night to be at our best the next day.
Treatment Options
The good news is that treatment is both available and effective. This includes light exposure, talk therapy, medication, relaxation and other mind-body (or, mindfulness) techniques, or some combination of them.
In 2007, the Journal of Consulting and Clinical Psychology published the results of a study comparing the effectiveness of light therapy versus Cognitive-Behavioral Talk Therapy (CBT), versus a combination of the two in treating SAD sufferers. They showed that CBT, combined with light therapy, produced the best results with 73% of subjects reporting a remission of SAD symptoms.
CBT alone, as well as light therapy alone, also resulted in significant improvements but not as dramatic. (Source: Rohan, K. J., Roecklein, K. A., Tierney Lindsey, K., Johnson, L. G., Lippy, R. D., Lacy, T. J., & Barton, F. B. (2007). “A randomized controlled trial of cognitive-behavioral therapy, light therapy, and their combination for seasonal affective disorder.” Journal of Consulting and Clinical Psychology, 75(3), 489-500).
On the medication front, the Mayo Clinic on its website offers this guidance:
Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.
An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants may also be commonly used to treat SAD.
Your doctor should recommend starting treatment with an antidepressant before your symptoms typically begin each year. They could also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.
Keep in mind that it can take several weeks to notice full benefits from an antidepressant. You might also have to try different medications before you find one that works well for you and has the fewest side effects. (Source: https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/diagnosis-treatment/drc-20364722).
Finally, mindfulness techniques can also help reduce symptoms and improve mood. These include breath control, muscle relaxation or other relaxation techniques, meditation, and guided imagery, to name but a few.
The thing to remember about all of these treatment options is that a combination of them, depending on the individual, may sometimes be the best option. Here at my practice, I offer CBT therapy as well as mindfulness training, and we collaborate with psychiatrists and other medical providers who prescribe antidepressants.
Want to know more? Please reach out to us.
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