Nothing Funny About SAD

It can come over you like a cold snap after a period of mild weather, when the outside takes on an icy stillness and colors seem to fade into gloomy greyscale. That’s how some people may describe the onset of seasonal affective disorder—SAD for short, which is a form of major depressive disorder that tends to kick in when seasons change, most typically during fall into 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, and increased agitation.

 Some may even experience suicidal thoughts.

 These are serious symptoms, yet often people with this condition are dismissed as 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 major depressive disorder (MDD), with some important differences. One is that whereas MDD can occur at any time, SAD tends to present when temperatures get colder, the days shorter, and sunlight less intense (more about this in a bit). Another concerns appetite. Persons with MDD tend to eat less and lose weight as a result. But those with SAD often crave carbohydrates and end up putting on weight.

At this point, let me add a word about the holidays. For a lot of us, myself included, that “magical” time between Thanksgiving and New Year’s becomes less magical and more bittersweet as we get older and 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 may also be an exaggerated, primitive survival response to winter, a season when weather can be harsh and food less abundant. Some mammals hibernate in order to conserve energy; our human bodies may just tell 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), prompting us to be active in the former and sleep in the latter. Light, either natural or synthetic, is a major zeitgeber. Some researchers theorize that people with SAD require a stronger exposure to light, in order to reset their circadian rhythms and thus sleep better, which will then, in turn, improve their moods and help them feel more energetic when awake.

 To Sleep, Perchance to Dream

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 our 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 in order to be at our best.

 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 percent 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 the following 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 also may commonly be used to treat SAD.

Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may 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 person and the specific combination, may sometimes be the best option.