When the days are getting shorter and the temperature colder, do you find yourself getting a little more irritable? Have a little less energy? Feel a little more moody? And if you find that this pattern is consistent year after year, starting every fall and disappearing each spring, you may be suffering from Seasonal Affective Disorder, or SAD.
Seasonal Affective Disorder is a subset of major depression, and may have general characteristics of daylong depression and low energy. Feelings of hopelessness or worthlessness, as well as no interest in activities that once were enjoyable are common. Poor sleep patterns, difficulty concentrating, changes of appetite or weight and feelings of agitation are also frequent. Specific to SAD include craving starches and subsequent weight gain, heavy feelings of the arms and legs, as well as trouble with interpersonal relationships including hypersensitivity to rejection and problems getting along with others.
Although the specific cause is not known, some factors are likely contributing to the development of the disease. It is season specific, commonly starting as days get shorter and diminishing as longer days return. The decrease in sunlight may disrupt your circadian rhythm or “bio clock” which sets your wake/sleep cycle. Disruption of this cycle may lead to depression. Reduced sunlight can also cause a drop of serotonin which is known to affect mood and contribute to depression. Melatonin, another neurotransmitter, can be disrupted by a shrinking photo period and will affect sleep patterns and mood.
Females seem to be more likely to suffer from SAD, but males may experience greater severity of symptoms. Younger individuals are at greater risk for SAD, however the risk does decrease with increasing age. Those with a personal history of depression or family history of Seasonal Affective Disorder are also more likely to have SAD. The greater the swing of day/night intervals, the greater likelihood of this disorder as well.
The diagnosis of Seasonal Affective Disorder may be difficult to make. Health problems and lab tests that contribute to depression need to be investigated. Additional types of depression may muddy the picture as well and need be considered. There are some factors that do support the SAD diagnosis if present for over two years. These include depression that begins during a specific season every year, and ends during another specific season annually, there are no episodes of depression during seasons of normal mood, and there are more seasons of depression than seasons without depression over time.
There are treatments for Seasonal Affective Disorder, but must be used with caution if there is a concern for additional underlying bipolar depression. Light therapy (phototherapy) involves exposure to a special type of light. The light source mimics the natural light of the outdoors and seems to influence the brain chemicals linked to mood. After days to weeks of consistent periods of exposure, this treatment seems to have a positive effect with most people suffering from SAD. Consult your doctor regarding light therapy treatment, as you need to assure the proper equipment for efficacy and safety. A common medication for preventing SAD is bupropion, an antidepressant. This may be considered for severe SAD, and is usually started every year before the onset of symptoms and continued beyond the usual seasonal recovery time before stopping the prescription. Psychotherapy can help control negative thoughts and behavior as well as assist developing healthy coping skills and stress management. Of course, should you identify with these symptoms, please consult your health care provider as soon as possible.
Bradford Croft, DO
East Flagstaff Family Medicine