As the weather becomes more chilly, pumpkin spice lattes make their return and colorful mums and fall décor come out, many of us welcome the beginning of fall. The air becomes brisk, kids enjoy soccer games and tournaments, and sweater weather is finally here. But not everyone finds joy in the transition to shorter days and longer nights. As a psychiatrist who treats children, adolescents and adults, many of my patients describe worsening mood and increased anxiety as the summer draws to an end. For some, changes in mood can be detected as early as August, as they anticipate the long winter ahead. While not all mood changes are pathological, some are severe enough and meet criteria to be considered Seasonal Affective Disorder or SAD. SAD is a form of a mood disorder and cluster of mood symptoms that can be seen as part of depression and anxiety, as well as bipolar disorder.
SAD affects 1-2% of the population and seems to be more prevalent in young people and women. The winter blues, or milder forms of SAD, may be more common, affecting 10-20% of people. SAD is more common the farther you are from the equator, and is most common in geographic locations at least 30 degrees latitude north or south of the equator. If certain symptoms crop up the same time each year, impact your quality of life and improve as the weather becomes warmer, SAD may be impacting you.
The term SAD is actually outdated, and the newest edition of the DSM (Diagnositic Statistical Manual – the standard we use to make diagnoses) actually coins it as Depressive Disorder with Seasonal Pattern. It is not a distinct disease, but a form of depression with onset of symptoms the same time every year. SAD does not always only occur in the fall or winter, a small subset of patients experience the seasonal depression in the spring and summer, although this is more rare.
What Causes Seasonal Changes in Mood?
Depression with seasonal pattern is thought to be strongly related to a disruption in the circadian rhythm. Circadian rhythm is your body’s internal clock that regulates your sleep- wake cycle. The area of the brain responsible for maintaining this rhythm receives light signals from the optic nerves. When it is dark, this area of the brain sends signals to the pineal gland to produce melatonin. Longer nights may disrupt the internal clock – causing one to feel groggy, disoriented and sleepy during the day.
Fewer hours of daylight also mean less synthesis of Vitamin D, a vitamin that is activated in the skin through sunlight. Studies have linked low vitamin D levels with depression and supplemental vitamin D may help in the production of the building blocks for neurotransmitters such as dopamine and serotonin, the ‘feel good’ chemicals of the brain.
What to Look Out For:
The following are symptoms of depression in general:
Depressed or low mood for more days than not, two weeks or more
Loss of interest or pleasure in activities you enjoyed
Changes in appetite or weight
Feeling angry, irritable, stressed or anxious
Unexplained aches and pains
Changes in sleep (too much or too little)
Difficulty with focus and concentration
Fatigue and loss of energy, low motivation
Using drugs or abusing alcohol
Feelings of sadness, hopelessness or despair
The following are symptoms that are more specific to SAD or a seasonal pattern of depression
- Feeling sleepy all the time or having trouble sleeping at night
- Low energy and difficulty with daily tasks
- Increase in appetite, especially craving carbs and starchy foods
- Weight gain
- Feelings of sadness, guilt, and down most of the time
- Feeling hopeless
- Avoiding people or activities previously enjoyed
- Feeling tense, stressed out and anxious
- Losing interest in sex and other physical contact
Also note that some of these symptoms can also occur in a seasonal and episodic fashion in individuals who have bipolar disorder.
What Can I Do About It?
There are several things that you can do to get yourself out of the winter rut! Here are a few suggestions I make to my patients.
- Natural Sunlight – it can be a challenge in Michigan, but try to get out as much as you can when it isn’t too cold or cloudy! Take short walks outdoors (weather permitting of course). Increase the amount of natural light in your home and workplace by opening drapes and blinds and sitting near windows.
- Get moving! The importance and power of exercise cannot be emphasized enough! Regular exercise can combat seasonal depression by boosting endorphins, serotonin and other ‘feel-good’ chemicals. Exercise helps energy levels, improves sleep and can boost self esteem. You don’t have to buy an expensive gym membership to get regular exercise, find a spot in your home and follow along with YouTube videos. Jump rope. Take a brisk walk if its not snowing or icy. Go to your local YMCA. Swim or take swimming lessons. Aim for at least 30 minutes of moderate activity every day, but start out with 3 times a week if every day is too much.
- Reach out to friends and family. Connecting with other people is a great way to help ones mood. There is power in connecting with others to help us feel better. You might not feel like making plans or getting out, but it will help you feel better when you do! Close relationships are vital to fighting the urge to isolating yourself. In many ways, doing the opposite of what you feel like doing can make a big difference. Volunteering your time for a good cause is another way to help you feel better. There are so many amazing causes in the Detroit area, pick one and make a commitment.
- Eat Right! Many people have a strong desire for carbohydrates and typical “comfort foods” in the winter. Try eating grains, oatmeal, fruits and vegetables instead – fight the urge to eat a lot of pasta, white bread and sugary foods. Foods rich in omega-3 fats, such as salmon, walnuts, and flaxseed, can improve your mood and may even boost the effects of antidepressant medications.
- Light Therapy – Has been studied and examined for decades and has been shown to be effective in up to 85% of cases of SAD. The timing and length of exposure may vary according to your symptoms and circadian rhythm. You may need guidance from your doctor or therapist and they can also help you choose the right type. Light boxes mimic sun light (without the harmful UV rays) and aim to suppress the daytime secretion of melatonin and help you feel more alert and energetic.
- See your doctor and ask about vitamin D levels and start supplemental Vitamin D. Vitamin B12 can also help with energy, talk to your doctor about this. If you are due for a physical, it might be a good time to go in for that check up and bloodwork to make sure there are no deficiencies going into the winter.
- If you have tried the above and your symptoms are severe and/or not improving, it may be time to see specialists who help individuals struggling with depression routinely. Therapy can help immensely to help you work through and process feelings and any problems you are having personally, at work or in your relationships. Consider seeing a psychiatrist or talking to your PCP about starting an antidepressant medication if symptoms have continued. Therapy and medication if indicated can help if the above suggestions are too overwhelming and you don’t know where to start.
- Regardless of the season, if you are having suicidal thoughts, go to your nearest ER, or call 1800-273-TALK or visit suicide.org to find a helpline near you. Visit afsp.org or the American Foundation for Suicide Prevention for more information on suicide prevention.
Sources and Resources:
Does Vitamin D Help with Seasonal Affective Disorder?
Seasonal Affective Disorder