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 testing, diagnosis and treatment.

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

The feeling has been described as depressed, but not quite suicidal ; sad but not as deep as when "mourning the loss of a loved one," and more like "a down-in-the-dumps" type of depression. People who live where the sun shines year-round without experiencing winter weather or cold temperatures can also experience Seasonal Affective Disorder.

If that sounds like you, then you might have what is called Seasonal Affective Disorder - SAD. It is a very real medical condition characterized by moodiness and fluctuating levels of depression.. Patients say their SAD symptoms begin with the arrival of late fall and lasts throughout the winter season. They lack energy and have no wish or want to do anything constructive until SAD ends in the spring at which time they are able to return to society.

Seasonal Affective Disorder is a mood disorder under the psychological heading of Clinical Depression, such as:

• 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.

If a patient already has been diagnosed with Bipolar Disorder, then SAD therapy should be considered part of their 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.

Lack of sunlight and outside influences play a big part in keeping SAD at bay.

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 zaps 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 place). People coming into the home can be met by such a depressed person that they choose not to stay very long.

These episodes of depression can last about four to five months, can cause 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 but 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.

Who gets SAD?

Elderly people, adolescents, those with chronic medical conditions, women who gave birth rencently and those who are going through menopause 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.

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

Many prescription drugs, such as estrogen, progesterone, contraceptives, gastrointestinal drugs, blood pressure, steroids, and acne medications list 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...People with Seasonal Affective Disorder should::

• Not drink alcoholic beverages
• Not take certain over the counter products like St. John's Wort'
• Check with physician before taking benzodiazepines like Valium, seizure medications like Dilantin, and insomnia medicines like Lunesta and Ambien.

Medications that can help Seasonal Affective Disorder are:

• Prozac (fluoxetine)
• Sertraline
• Celexa
• Wellbutrin XL

Buproprion and Prozac (Fluoxetin) are the only prescription medications approved to treat people with Seasonal Affective Disorder (as of 2020)

Evaluation

If a physician suspects a patient has 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

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Harvard Health Medical School

American Family Physicians