What Is Seasonal Affective Disorder (Sad) and How Is It Treated?

The information in this article is for reference only and is not to be used as medical advice. Please consult your medical provider for any treatment and diagnosis.

Have you ever experienced a really bad case of "The Blues?"

You know ... that sad feeling that you can't quite put your finger on ... not exactly "mourning-the-loss-of-a-loved-one kind of sad" nor "the kind of sad that borders on being suicidal" but rather "a winter doldrums, down in the dumps-type of depression."

You might have what is called Seasonal Affective Disorder - SAD. It usually occurs in wintertime when more time is spent indoors away from friends and it is a real medical condition.

People with Seasonal Affective Disorder (SAD) usually dread the arrival of the fall and winter season each year which is why it is often called winter-onset SAD, winter blues or winter depression.

People who experience Seasonal Affective Disorder report that their symptoms start around the same time each year and that it literally takes away all their energy, makes them moody and depressed, and causes them to hibernate. They literally pull in the carpet until spring and then return to society once spring has sprung.

What if you are one of those people who lives in a place that is a year-round sunshine paradise, where harsh winter weather never rears its ugly head?

Are those people so lucky that they never experience Seasonal Affective Disorder?

Though it is mostly associated with winter, it can affect anyone during any season of the year in any part of the world.

Seasonal Affective Disorder is a mood disorder coming under the psychological heading of Clinical Depression, some of which encompasses but is not limited to:

• Premenstrual Dysphoric Disorder (PDD or PMDD)
• Dysthymia (mild depression)
• Major Depression
• Atypical Depression
• Post-Partum Depression
• Seasonal Affective Disorder (SAD)

In the extreme, periods of depression alternating with episodes of excessive energy and activity can meet the criteria for Bipolar Disorder, previously called manic-depressive illness, although it is the rare case when SAD would progress that far.

However, if the patient already has been diagnosed with bipolar disorder, then it is imperative that SAD therapy be considered as part of the treatment plan.

The research I've read says that the farther away you live from the equator, the more likely you are to experience SAD because of the shorter days and the lack of sunlight.

But lack of sunlight isn't the only factor disrupting the lives of people with Seasonal Affective Disorder.

With SAD, sleep patterns can be noticeably altered which affects moods. It also causes a drop in serotonin and melatonin levels which can lead to depression and lack of energy. It ravishes your appetite (sometimes for the better, but usually for the worse) and saps your energy.

Disruptive sleep patterns aren't associated with just the change in seasons. People who work shift work or change their work shifts frequently interrupts the circadian rhythm.

The SAD sufferer normally wants little or nothing to do with social interaction outside of the home (their safe environment). People coming into the home can be met by such a depressed person that they do not stay very long.

These episodes of depression, which last about four to five months, include fatigue, sleeplessness and a tendency to overeat (particularly carbohydrates). Conversely, there is a small percentage of people with SAD who have a tendency to under-eat and they sleep for long periods of time.

Genetics

Depression linked to Seasonal Affective Disorder is not gender-specific, although women have twice the rate of depression than men and it varies in degrees with the person. The elderly, adolescents, women who have given birth or are going through menopause and those with chronic medical conditions can be predisposed to Seasonal Affective Disorder.

According to a 2011 New York Times article, researchers studied groups of parents, siblings and especially twins and found a strong genetic link where depression runs in families.

Second and third generation relatives were likely to experience a deeper depression if someone in the first generation has been diagnosed with it.

Medications

Many prescription drugs, such as estrogen, progesterone, contraceptives, gastrointestinal drugs, blood pressure, steroids, and acne medications have depression as a side effect. Factor in some of the other symptoms of Seasonal Affective Disorder and a minor depression could easily become a major depression.

Evaluation

If a physician suspects Seasonal Affective Disorder, to determine the severity he should conduct a full evaluation using the current DSM-IV depression criteria, the Beck Depression Inventory and the Hamilton Rating Scale for Depression.

Underlying Factors

It is equally important to determine if the depression the patient is experiencing is alcohol or medication-related or if it is cyclical, that is, happening at a certain time of the year or when a certain event occurs in their lives such as a recent change of residence, chemotherapy treatments or other recurring treatments, divorce, separation anxiety of a parent, child, or spouse, husband left on a work trip, etc..

Patient's Preference

The patient should always be in control of their treatment options. and get a second or even a third opinion to be comfortable with their treatment plan. The treatment for Seasonal Affective Disorder should vary with each patient's preference.

It is okay if the patient decides not to have any treatment. Considering the side effects of certain medications, sometimes no treatment is the best treatment.

Anti-Depressant

If the patient agrees with a physician to treat their condition with medication, he will usually suggest an anti-depressant medication to help combat the highs and lows of mood swings and depression. This is the time to talk to him about alternative medicine, as discussed below.

Cognitive Behavior Therapy (CBT)

Cognitive behavior therapy with a licensed psychologist is a good option for patients who are comfortable talking with a therapist.

Light Therapy

Some patients suffering with SAD say that using light therapy for 30 minutes per day for the duration of the winter season has provided good results. However, some patients report that when they discontinued light therapy after a week or two, their symptoms returned in intensity.

Possible but mild side effects using light therapy: headache, nausea, eye strain, blurred vision, and agitation.

Light therapy units range in price from $150 to as much as $600 with an average of $250. Medical insurance usually doesn't reimburse this type of therapy since it is not recognized as medically necessary. It never hurts to ask the doctor for a letter of medical necessity to see if the insurance company will pay for the unit. You'll never know unless you try.

Negative Air Ionizers

Some patients use negative air ionizers, trying to trick the brain into thinking it is summertime. I have no idea whether that works or not, but I do know that if it is 10 degrees outside, nothing will convince my brain that it is summertime.

Dawn Stimulation

A preset timer turns on a light fixture before a patient awakens. The intensity of the light gradually increases over 90 minutes. Studies are optimistic.

Blue Light

The retina is sensitive to blue light and this affects circadian rhythm. Studies are still being conducted whether blue light has the same benefit as white light.

While alternative medicine shouldn't be your first "go-to" place, there are some remedies that could significantly help you in your treatment plan.

Certain supplements and suggestions listed in this article may interfere with the function and effectiveness of certain anti-depressants, chemotherapy drugs, birth control pills, diet pills, blood pressure medications and certain changes in diet plans.

Before you take anyone's advice or start using home remedies (even if it is only vitamins or supplements), consult your medical provider to ask which supplements and over-the-counter remedies might affect any medications you are presently taking.

The Society of Light Treatment and Biological Rhythms

Motherboard Vice

Harvard Health Medical School

American Family Physicians