Understanding seasonal affective disorder
Alicia J. Kaplan, M.D. Medical Director Center for Adult Anxiety & OCD at AHN
Each autumn and winter, the short days, long shadows and gray skies can have a major impact on the mental well-being of those living in Western Pennsylvania. Seasonal Affective Disorder, or SAD, is often a form of clinical depression — or Major Depressive Disorder — that is triggered by seasonal changes, often clearing up as spring arrives.
If you think you might be exhibiting SAD symptoms, you’re not alone. Millions of Americans experience a worsening mood, low energy levels and fatigue this time of year. Others may find it challenging to get out of bed on days when even the sun seems to be hibernating.
While only time will tell whether Punxsutawney Phil’s early spring forecast is accurate, there is a light at the end of the tunnel for those who feel stuck in a rut due to SAD.
Why does SAD occur and what does it feel like?
The causes of SAD aren’t fully known, though it may involve the alteration in circadian rhythms and abnormalities in melatonin release in the brain.
Most people, however, attribute it to the shorter length of natural daylight in the winter. It’s believed that 5-6% of the U.S. population is affected by SAD, which can have varying severity. An additional 15% of the population experiences a subclinical form of SAD known as the “winter blues.”
SAD is also believed to increase in prevalence with distance from the equator. In America, that means the farther north you go, the morecommon it is.
Peaking early in the calendar year, SAD often builds on the anxiety of a stressful holiday season. For those who may already be suffering, even small gatherings can bring on more anxiety. School weather delays and shoveling snow after a storm can also compound the depression.
SAD symptoms mirror those for Major Depressive Disorder — feeling down most of the day, every day, for at least two weeks, or having decreased interest in activities that are typically enjoyable. SAD can also cause additional symptoms that might be atypical for MDD, such as decreased energy, increased sleep and weightgain.
Offsetting SAD until spring arrives
Brighter days are literally ahead but, until they arrive, prioritize a healthy diet and good habits, including:
Because SAD is seasonally predictable, making plans to get ahead of symptoms can help, as it’s easier to plan when your mind is in the right place. You might declutter a window space to get more natural light, or even strategically plan a trip to a sunny location in the winter months.
Maintaining social connections is also important this time of year, despite the inclination to stay under a blanket and watch Netflix. Try to schedule a regular meetup with friends.
Following good sleep hygiene during the winter months can offset daytime grogginess. Watch your caffeine and alcohol intake; if you have trouble getting up in the morning, try a dawn-simulating lamp that brightens your room gradually before the sun comes out.
Getting exercise is beneficial too. Even on cold and cloudy days, bundling up and getting outside for an hour can be a huge boost to your mood. On days when the sun makes an unusual appearance, take advantage of it: Sunny days are associated with improved SAD symptoms in the winter.
If the sun isn’t cooperating, extending the daylight hours by using artificial light can also have an antidepressant effect. Research shows that bright-light therapy is effective for approximately 60% of SAD patients.
Bright-light lamps of 10,000 lux are easy to find and an inexpensive way to simulate sunlight in the winter. It’s advised to use these early in the morning, within 15 minutes of waking, to reap the full benefits. Be sure to position the lamp at a safe distance from your eyes, and check with your doctor before using if you have any issues with your eyes or are using photo sensitizing medications.
Know when to seek professional help
For more severe cases of SAD, psychotherapy and antidepressants (and/or other medications) may be required.
Medication for those who experience SAD may be started in the early fall and then discontinued in the spring if appropriate. (Patients already taking medication for a preexisting anxiety disorder may see benefits year-round for their usual anxiety as well as their exacerbated seasonal depression.) Psychotherapy, commonly known as “talk therapy,” may also help develop strong coping strategies.
Individuals with recurrent, severe SAD should be screened for more acute symptoms of clinical depression including hopelessness, worthlessness, guilt or suicidal thoughts, which require immediate management. If your SAD symptoms become more concerning and your life and work become significantly disrupted by your feelings and behaviors, seek professional help.