Seasonal Affective Disorder (SAD)

It’s that time of the year again. You begin to see signs of change starting in October. The air is feeling crisper, temperatures are dropping, and the leaves of trees are beginning to change color. Welcome fall and pumpkin spice everything! But besides the pumpkin spice fall is also the awareness that winter is coming. And I think we can all agree that both fall and winter bring shorter days, holidays, and increased stress.

Most of us are affected by the change in seasons – it is normal to feel happier and more energetic in the summer when the sun is shining and the days are longer, or to find that you eat more or sleep longer in winter. However, if you experience Seasonal Affective Disorder (SAD), the change in seasons will have a much greater effect on your mood and energy levels and may lead to symptoms of depression that can have a significant impact on your day-to-day life.

What is SAD and what causes it?

So, what exactly is SAD? Well, SAD is a type of depression that is related to the change in seasons. The medical diagnosis of SAD, now referred to as "depression with a seasonal pattern", is a specific type of recurring depression that people experience during a particular season, typically the fall and winter months of the year, generally October through April. The causes of SAD are not yet fully understood. However, various experts believe the following to be some of the causes.

• Insufficient exposure to sunlight: During the fall and winter there is a significant decrease in the amount and quality of natural light that we receive here in Michigan. So much so that Grand Rapids, MI ranks as the 6th cloudiest city in the nation. The lack of sunlight can cause the brain to produce less serotonin, which is a chemical responsible for maintaining mood balance and happiness. Essentially you can think of serotonin as a neurotransmitter that allows we humans to “feel good”.
• High melatonin levels: Lack of sunlight can also impact the production of melatonin, a hormone that controls our sleeping cycles. When it is dark the body is triggered to increase the production of melatonin to prepare us for sleep. When it becomes light out the body is triggered to decrease the production of melatonin to prepare us to be awake. Due to the combination of decreased natural light and an earlier sunset (Thanks daylight savings time) the body can become confused and produce more melatonin than needed. With excess melatonin an individual can feel sleepier and appear more sluggish.
• Low levels of Vitamin D. New research is beginning to explore the link between a deficiency in vitamin D and the occurrence of SAD. Michael Kimlin, of the Queensland University of Technology in Australia, says that vitamin D also plays a part in the synthesis of both dopamine and serotonin, noting that past research has associated low levels of these neurotransmitters with depression. Kimlin states that, "It is logical that there may be a relationship between low levels of vitamin D and depressive symptoms. Studies have also found depressed patients commonly had lower levels of vitamin D." 

Symptoms of SAD

Symptoms of SAD can include the following:

• Depressed mood regularly occurring during the fall and winter months;
• Excessive sleeping;
• Lack of energy, with daytime fatigue;
• Heavy, "leaden" feeling in the arms or legs;
• Increased appetite and weight gain;
• Social withdrawal (feel like “hibernating”);
• Difficulty concentrating and Increased irritability;
• Losing interest in activities you once enjoyed;
• Feeling hopeless or worthless;
• Having frequent thoughts of death or suicide;
• Loss of Libido; and
• Increase in severity of symptoms during menstrual cycles

It can sometimes be hard to tell the difference between SAD and other types of depression because many of the symptoms are the same. SAD may begin at any age, but it typically starts when a person is between ages 18 and 30. Kelly Rohan PhD, professor of psychological science at the University of Vermont states that SAD is clinical depression, and the way that it is diagnosed is to determine if the depression follows a seasonal pattern.

If someone believes they may have symptoms of SAD, they should seek the help of a medical professional. Just as with other forms of depression, it is important to make sure there is no other medical condition causing symptoms. SAD can be misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections, so proper evaluation is key.

Treating Seasonal Affective Disorder

There are various ways of treating SAD, some of which require one to see a physician while others require counseling or can be done independently through changes in lifestyle.

Treatment through a Physician:

• Light therapy (phototherapy) – A light therapy box mimics outdoor light. Researchers believe this type of light causes a chemical change in the brain that increases serotonin production and decreases the production of melatonin. Your physician may recommend a specific light box, but generally the lightbox should provide an exposure to 10,000 lux of light and emit as little UV light as possible. Light boxes are designed to be safe and effective, but they aren't approved or regulated by the Food and Drug Administration (FDA) for SAD treatment, so it's important to consult your physician.
• Use of antidepressants – Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat SAD. The FDA has also approved the use of bupropion, another type of antidepressant, for treating SAD. As with other medications, there are side effects to SSRIs. Talk to your doctor about the possible risks of using medications. You may need to try several different antidepressant medications before finding the one that improves your symptoms without causing problematic side effects.

Treatment through Counseling

Counseling can help individuals identify and change thinking and/or behavior patterns that may be harmful or ineffective and replace them with more helpful thoughts and behaviors. There are many modalities of therapy that can help individuals create change.

• Cognitive Behavioral Therapy (CBT) – CBT is a type of talk and behavioral therapy in which individual’s reality test their often-irrational thoughts. Clients work to become more aware of their negative thinking patterns and work to reframe negative thinking patterns into more positive thinking. The goal is for individuals to recognize how their thinking influences their emotions which impacts their behaviors.
• Acceptance and Commitment Therapy (ACT)- ACT is an action-oriented approach to therapy. Clients learn skills to stop avoiding and struggling with their emotions, and instead work to accept and engage with them while simultaneously taking steps to change their behavior as well.

Treatment through change in Lifestyle

Lifestyle can be a huge contributor to our quality of life as humans, and this is something that we often have more control and ability to influence. Here are some lifestyle habits to consider working towards when addressing SAD.

• Spend time outdoors during the day.
• Get as much light as possible and avoid dark environments during daylight hours.
• Allow natural light to shine through open windows and doors when temperatures are moderate.
• If possible, rearrange work-spaces and work near a window, or set up bright lights in your work area.
• Avoid staying up late, as much as possible, which disrupts sleep schedule and biological clock.
• Eat meals that have limited amounts of processed food.
• Increase intake of fruits and vegetables.
• Do NOT Isolate! Even if you don’t feel like socializing, force yourself to spend time with people that add value to your life.
• Regular exercise, particularly outside

Symptoms of SAD can be difficult to manage, but they are manageable. If after reading this you find yourself curious about different options of treatment, whether it be counseling, nutrition, or movement the Office of the University Physician has many services available to you. Please take a peek at our various services. In particular why not check out our Health4U and EAP programs? Our staff is happy to help in any way that we can.