Category: Depression

By Jennifer Farley, PsyD
Associate Chief of Psychological Services, Lindner Center of Hope

 

 

 

In many areas, autumn’s colorful trees and darker mornings are reminders of the transition from summer to winter. Evening hours just don’t feel the same compared to the long days of summer when people are more active from sunrise to sunset. While it is common to experience life differently at different times of the year, approximately 10 to 20 percent of people in the United States experience a mild depression during the darker seasons, and 4 to 6 percent of Americans experience moderate or severe depression.

Seasonal Affective Disorder (SAD) is a clinical depression triggered by seasons of the year. SAD is believed to be associated with seasonal changes in the amount of daylight. For most people with SAD, symptom onset is in the fall or early winter, and relief starts in spring. Symptoms of SAD can last up to 5 months. SAD is more common in women than men and is typically not experienced prior to 20 years old. SAD is more common among young adults and the risks of developing SAD decrease with age. People with a depressive disorder or Bipolar Disorder and people with family members with SAD or other forms of depression raises the risk of having SAD. Living in sunnier regions and closer to the equator decreases the risk of SAD, validating why many people become “snow birds” and go south for the winter.

Because SAD is a depressive disorder, individuals experience at least some symptoms of Major Depressive Disorder. These can include feeling depressed most of the day, nearly every day, having less interest in enjoyable activities, sleep problems, feeling sluggish or agitated, having low energy, and feeling hopeless or worthless. Additional symptoms can include overeating, social withdrawal, and poor concentration. It is common for people with SAD to oversleep by going to bed earlier and/or waking later. A clinical diagnosis of SAD requires a full remission of symptoms when the season ends and 2 consecutive years of episodes in the same season.

Causes of SAD include lower levels of the neurotransmitter serotonin, disruption of the circadian rhythm, increased melatonin, and a deficiency in Vitamin D. SAD is most typically diagnosed by primary care physicians, but psychiatric clinicians (medication prescribers and therapists) can also identify SAD.

Though there is not much that can be done to avoid getting SAD, symptoms can be managed to reduce their intensity. Some people start treatment or interventions before SAD symptoms start or before the season changes. Methods of treatment include light therapy (i.e., light boxes), medication, cognitive-behavioral therapy, increased Vitamin D, and lifestyle changes. Taking care of one’s body by eating healthy and getting sufficient sleep, exercising, and avoiding alcohol and drugs can help. Managing stress is important, as is being around others. Isolation and loneliness may fuel depression. Planning pleasant daily or weekly indoor or outdoor activities can be helpful to help fight “hibernation”. People also benefit from planning a vacation somewhere warmer and sunnier during the winter, and the experience of anticipating something positive helps reduce depression. Though some people use tanning beds in the winter months, this is NOT recommended due to the harmful exposure of U/V rays.

Individual therapy and/or medication treatment can be quite helpful for those with SAD, and it is especially recommended when depression is at a moderate or severe intensity. Cognitive-Behavioral Therapy in particular helps by replacing negative thoughts about winter with more positive thoughts. Discussing ways to implement lifestyle changes and planning for enjoyable activities can be helpful. Therapy can also offer opportunities to learn and practice mindfulness and to explore how to radically accept the fall and winter by “leaning in” to its opportunities. People do not have to live through darker months with dark mood.