Don’t be SAD
Since winter is in full effect we need to talk about a serious topic known as, SAD. And yes we are SAD to hear about this but the winter blues are really real for some people.
What is SAD?
SAD stands for seasonal affective disorder and it is a subtype of depression (you can guess by the name that it is due to certain seasonal changes). It usually occurs during the same and yearly. Typically, it starts around fall and continues well into the winter months. Of course, your geographical location definitely matters in these situations. For example, if you are closer to the equator then your days are longer so you are less likely to experience these symptoms. However, there are some people that have this in the spring or summer but, you can see how that can be rare. People like nice weather and nice weather makes you happy!
Symptoms of SAD are "moody-like" symptoms but they are continuous aka you’re not just moody but you are literally depressed and nearly all the time. To fit the description of a full blown depression you need to meet a key component something we in medicine call ANHEDONIA which literally means a loss of interest. Other symptoms include, low energy, sleep disturbances (either sleeping a little or too much which can vary from person to person), weight changes (loss or gain), problems concentrating, feelings of hopelessness, worthlessness or unspecified guilt, feeling agitated or slow, thinking of hurting yourself or thoughts about death in general (in some cases this can include suicidal thoughts, although not everyone who is depressed needs to experience suicidal thoughts).
This can further be divided based on the season. So with the more common winter-onset SAD you can experience symptoms of sleeping too much, appetite changes (eating more carbs), weight gain, tiredness or not having energy to do things. With summer-onset SAD you may experience other symptoms such as, insomnia, poor appetite, weight loss, anxiety and agitation.
In any case, it is important to rule out other psychiatric causes because there can be other things going on that can replace this diagnosis or confound it. So it is very important to make sure you are diagnosing each patient correctly. For example, patients with bipolar disorder may also experience seasonal changes in behavior and suffer from depression during the winter months or mania during the summer months.
What causes this disorder?
It is believed that many factors play a role but the actual root cause is not yet known. People say it may be related to your internal biological clock or circadian rhythm. If we think about this logically we can see why that may be right? You have less sunlight, it gets darker earlier which can disrupt your body's own clock making you feel more depressed and tired because your days are now shorter.
Serotonin levels are really important in that respect. This one is a biggie because you know, hormones! These hormones affect your mood. It is known as the “feel good” hormone and without sunlight you can have a drop in this hormone.
Melatonin is another great piece to this puzzle because it has to do with your biological clock. Melatonin is known to affect your sleep (which is why some of us take it to help with sleeping) and poor sleep goes hand in hand with your mood.
Who is at risk?
So let's start with the basics: it is more likely to occur in women than men and younger adults versus older adults. Other risk factors include if you have a family history (since we know that depression has a familial predisposition this likely does to), having a history of major depressive disorder or bipolar disorder, and geographical location (if you live far north or south from the equator your winter days have shorter time periods of sunlight).
How do we diagnose it?
You need to come in for an appointment and be screened. Obviously, as we discussed earlier as a physician we want to make sure we're not misdiagnosing since many of these disorders may have overlapping features. So someone will take your history and do a complete physical exam to start with. You will also need a basic blood work as certain other conditions can mimic these including low vitamins levels, anemia, etc. You will likely be screened for depression and asked personal questions (don’t be alarmed as this is all confidential but just part of the protocol to get to the root of what’s causing your symptoms). You may or may not need to see a specialist (likely a psychologist or psychiatrist) for further evaluation.
How do you treat it?
Something called phototherapy or light therapy is usually the first line treatment followed by pharmacologic management or psychotherapy. This is a really important part so let's expand on these a little further:
How does it work? This is awesome honestly. So, you get a special light box that sits a couple feet away from you and it is BRIGHT. You are exposed to it when you wake up and you do this everyday. Basically, this light is supposed to mimic natural outdoor light which tells your neurotransmitters to wake up and affect your mood. It takes about a few days to a few weeks to start working.
For those who have more severe symptoms and who fail an appropriate trial of light therapy next up would be medications or therapy. The medications would be antidepressants typically an extended release version (which is a once a day tablet that lasts 24 hours like Bupropion... you may have seen this one in commercials marketed under the brand name, Wellbutrin). This can help prevent depressive episodes in those people who have a history of SAD. Really, many antidepressants can be used for this but the medication dosage and specific medication type may change from person to person. Some may have you take it before the onset of symptoms while some may have you take them for some time even after your symptoms resolve.
In general, antidepressants take about 4-6 weeks to take effect and they do come with side effects so you as well as, your doctor should come up with an appropriate plan.
Note: if you have bipolar disorder they can be triggered by antidepressants and light therapy so please be aware to disclose all and any medical background to your physician.
Finally, psychotherapy aka talk therapy is a type of cognitive behavioral therapy (CBT) that is used to treat many psychiatric conditions. In this particular case, you can identify negative thoughts or behaviors that worsen your symptoms, learn to manage stress, to cope with SAD, to schedule certain activities that may help alleviate the symptoms and avoid triggers.
Other things to help with coping with SAD:
Try to use relaxation techniques (YOGA is a great one)
Music or art therapy
Open up those blinds or have a home with a window in your room
Take walks during the day, if possible
Get in exercise (Remember what they said in legally blonde? "Endorphins make people happy!")
Take care of yourself! That means: drink enough water, get enough sleep, eat a healthy diet and get ME time
Socialize with those around you... once in a while
Go take that vacation you've been eyeing for some time
Find ways to eliminate stress (see 9&10 which may or may not work for you)
Whatever you do and whatever plan works for you stick with it. You know how much we love consistency.
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Disclaimer: The Content on our podcast/website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.