“‘Tis The Season To Be Sad:” Seasonal Affective Disorder

​As I write this, the flurries of snow outside my window quietly announce their first arrival for the season. Time, I am reminded, to prepare myself for what lies ahead. Winter is here. When flurries become blankets, a rush of anticipation runs through my mind and everything seems fresh, gleaming, pristine. Then I venture outdoors into the winter weather and it catches my breath with a feeling of renewal and hopeful anticipation. Festive lights, holiday cheer, family gatherings. Not everyone shares these thoughts and emotions this time of year. 

Seasonal Affective Disorder (SAD) is a clinical mental disorder that affects between 10 and 20% of the adult population, at least to a mild degree. Approximately 5% suffer from its more severe effects. Women outnumber men who suffer from it by a ratio of 4 to 1 and statistics show that the farther one lives from the sun, viz., geographically distant from the equator, especially in the northern hemisphere, the more prevalent this condition is. And while most people get SAD in the fall and winter seasons, 10% of the population who suffer from it, paradoxically, fall prey to its effects in the spring and summer. People who suffer from depression or other mood disorders, such as bipolar disorder, are especially susceptible to SAD.

Although SAD is mostly a disorder among adults, according to a wellness blog by Renown Health, one million children in the U.S. also have it. Because children often don’t manifest symptoms the same as adults the signs to look for include increased irritability, complaints about headaches or stomach aches, and, especially for children with ADHD, increased inattentiveness. For adolescents, SAD is more likely to show in their academic performance or ability to get up in the morning as well as some of the classic symptoms of depression such as a decreased interest in activities, difficulty concentrating, and an increase in appetite, especially for foods high in carbohydrates. 

What is SAD and What Causes it?

Seasonal Affective Disorder has all the symptoms of major depression. The only difference between them is that SAD, unlike clinical depression per se, occurs on a seasonal cycle. A survey of its symptoms, therefore, constitutes all the symptoms that define major depressive disorder. They include symptoms of fatigue, sadness, loss of interest and enjoyment in life, poor concentration, insomnia and hypersomnia (sleeping too much), excessive appetite (especially for carbohydrates), feelings of hopelessness, and suicidal ideation. In order for a diagnosis of SAD to be rendered, these symptoms must be present at least two weeks in duration. 

It is believed that SAD which is caused by the effects of diminished exposure to sunlight may be explained by the way our brain is influenced by light and the physiological functions of the body that are cyclical in nature. According to her blog, “Everything You Need to Know About Seasonal Affective Disorder,” (November 4, 2015) crosstalk.cell.com, Jennifer Levine cites studies that have shown how the regulation of serotonin, a neurotransmitter that influences mood, is especially affected by changes of the seasons in people diagnosed with SAD. Scientists further speculate, says Levine, that a region of the brain known as the dorsal raphe nucleus which regulates our circadian rhythms, as influenced by the natural hormone, melatonin, might be a contributing factor as well.

How Do We Treat SAD?

Although there isn’t much we can do about the climate in the region where we live that determines how much sunshine we can be exposed to, beyond the salubrious effects of vacationing in the tropical islands every winter, there are several ways one may modify its effects on our mood. The following is a list, many of which may be found on the website of the American Psychological Association that gets updated regularly, of ideas you may use to prevent getting the winter blues, or worse, Seasonal Affective Disorder:

1. The most obvious and direct way to treat SAD is to get more exposure to sunlight. For this reason, especially during the winter season, try to get outside at least 15 minutes a day and, of course, be sure to wear your sunscreen. 
2.  If you are unable to get outdoors for any reason, sit by a window or try to get more light into your home. Decorate your home or paint your walls light-reflective colors. Use lightbulbs that are brighter or that simulate sunlight.
3.  Light boxes, or what are sometimes called “Happy Lights,” have been shown in multiple studies to effectively alleviate the symptoms of SAD. These devices have been around for decades and, since they were first introduced, have become relatively inexpensive. Light boxes simulate the sun’s light waves emitting 10,000 LUX. It is generally recommended to use a light box 15 to 30 minutes a day. I usually use one on those cloudy winter days we often have here in Connecticut. Be sure to position the device to the side, not directly in front of you, and do not look directly into the light when it is in use.
4.  Exercise regularly. It is not just good for your health; exercise relieves stress, improves mood, and creates an over-all feeling of well being.
5.  Winter is the time, more than ever, to share with other people, family and friends, and therefore why we have a holiday season this time of the year. Sharing time with others and fostering a strong support system contribute to longevity and good mental health. 
6.  Cognitive-behavior therapy, or CBT, has been shown to effectively treat depression and other mental health conditions by helping patients examine and address distortions in thought process that can contribute to depression.
7.  Although it is not a “magic bullet,” antidepressant medication, often in conjunction with other methods to address the symptoms of depression, can be a useful tool in the SAD arsenal. They, of course, require a trained, licensed professional to prescribe them for you.
8.  Watch your diet. People with SAD have particular cravings for carbohydrates, especially the unhealthy ones. A “sugar high” is a short fix whose aftereffects can actually exacerbate lethargy associated with depression, known as the “sugar blues.” Conversely, try to maintain a healthy, more nutritious, diet, with lots of fruits and vegetables, especially during the winter months for this reason.
9.  There has been some evidence suggesting that Vitamin D can help prevent depression. Many people suffer from Vitamin D deficiency and for this reason many physicians routinely order it be tested as part of their patients’ annual check-up. It is widely known that Vitamin D can most easily and effectively be obtained by exposure to the sun. You can also get it from certain kinds of foods such as salmon, dairy, tuna. oranges, and soy. Vitamins B6 and B12 are also known to support cognitive function and mental alertness as well as to help ward off fatigue which is a common symptom of depression.
10.  Finally, even the U.S. Congress can do their part to fight SAD. Earlier this year, the Senate chamber unanimously passed a bill introduced by Senator Marco Rubio known as the Sunshine Protection Act which fixes our daily clocks at daylight saving time. Research has shown that the period of transition to a new time schedule that occurs twice a year is associated with an increased risk of heart attacks. If enacted, this bill would increase the amount of time most of us are exposed to sunlight while also eliminating the stress of adjusting to a new schedule every six months. Unfortunately, the bill remains stalled in the House chamber so that passage is not likely until perhaps as long as at least another two years pending completion of a study conducted by the Department of Transportation to determine the long-term effects it would have on commerce and safety across the United States.