Friday, January 30 2015 7:05

Understanding Seasonal Affective Disorder

Written by Kevin Caputo, M.D.

It could be more than just a case of the winter blues.

Many people are affected each year by Seasonal Affective Disorder (SAD), a form of depression that, as the name suggests, is directly related to the seasons. SAD is most common during the fall and winter, yet some people are affected in the spring and summer.

Symptoms of SAD occur during the affected months and get progressively worse. Then, once the seasons change, the symptoms disappear. SAD can be difficult to diagnose separately from depression. But fortunately once it’s diagnosed, SAD can be treated.

What Are the Symptoms of SAD

The symptoms are very similar to those of regular depression, but they occur only seasonally. Symptoms can include feeling depressed, having low energy, feeling hopeless or worthless, losing interest in activities, as well as sleep problems, changes in appetite or weight, difficulty concentrating, feeling sluggish or agitated, or having frequent thoughts of death or suicide.

Some symptoms are specific to either fall and winter SAD or to spring and summer SAD. Fall and winter SAD symptoms include problems getting along with other people, hypersensitivity to rejection, a heavy feeling in the limbs, weight gain and oversleeping. For spring and summer SAD, symptoms include trouble sleeping, weight loss and poor appetite.

Causes of SAD

There are several causes of SAD, and most are related to changes in your circadian rhythm, serotonin levels and melatonin levels. Most of these causes are a result of lower levels of sunlight, which is why SAD is more common in the winter.

Reduced sunlight can affect the body’s biological clock (circadian rhythm) and lead to feelings of depression. This change in our circadian rhythm can cause a drop in serotonin levels that can then lead to depression. Seasonal changes can also affect melatonin levels, which play a large part in mood and sleep patterns.

Testing for SAD

If you believe your life is being affected by SAD, you may want to see your doctor or a mental health professional. A physical exam, lab tests and a psychological evaluation can be used to determine if you’re suffering from SAD. Sometimes, there can be underlying physical health problems linked to depression, such as thyroid problems, that appear in lab test results.

The most difficult part of diagnosing SAD through a psychological evaluation is distinguishing SAD from depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, identifies four main criteria used to diagnose SAD: depression that begins during a specific season every year, depression that ends during a specific season every year, no episodes of depression during the season you experience a normal mood, and many more seasons of depression occur than seasons without depression over the lifetime of your illness.

Treatments for SAD

Because SAD is often caused by loss of sunlight in winter, a common treatment is light therapy, also called phototherapy. During this treatment, you sit close to a special light therapy box that emits a bright light that simulates sunlight. The theory is that your body gains the bright sunlight that it’s missing during the darker months. This treatment can help with fall and winter SAD.

Medication is another treatment option for SAD, and many who suffer will benefit from antidepressants. Psychotherapy, or talk therapy, is a third treatment option, and it works in similar ways to treating depression.

Lifestyle Changes

Lifestyle changes can often help those suffering from SAD. For example, you can get outside more in the sunlight, and make your home environment brighter by opening blinds, shades and windows. Exercising regularly also helps relieve stress and anxiety.

Some over-the-counter supplements can help with SAD symptoms, such as a synthetic form of melatonin and omega-3 fatty acids, which have been shown to lower depression.

The most important part of coping with SAD is living a healthy and scheduled lifestyle. I recommend that you exercise regularly, eat right, reduce stress levels and socialize and surround yourself with people who can improve your mood.

Board certified in adult psychiatry, Kevin Caputo, M.D., is a psychopharmacology specialist who has worked extensively in the areas of adult attention deficit, anxiety disorder and mood disorder. He currently serves as chairman of the Department of Psychiatry at Crozer-Chester Medical Center and president of Community Hospital.

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