Learn about the symptoms, causes, and effective coping strategies for Seasonal Affective Disorder (SAD) on Meri Sehat.

Seasonal Affective Disorder (SAD)

Online Consultation

Ismail Munir

Overview

Also called winter depression, seasonal affective disorder is a subtype of <a href="https://merisehat.pk/disease/depression">depression </a>with a seasonal pattern. 
Seasonal depression, also known as seasonal affective disorder (SAD), affects people for a brief period of time, causing them to feel sad or uncharacteristic of themselves.

&nbsp;

Seasonal depression is basically the feeling of sadness that hits an individual when the days get shorter and the nights get longer, which is the season of late fall and winter. This is why it&#39;s also called &quot;winter blues&quot;. It is a form of depression or mood disorder that takes place every year at the same time. However, there is a rare disorder termed &ldquo;summer depression&rdquo; which sets about in late spring or early summer and typically ends in fall. 
&nbsp;

Despite having an abundance of sunlight and being a tropical nation, seasonal mood disorder exists in Pakistan. According to the Journal of Pakistan Medical Association (JPMA), seasonal depression has been observed in a number of individuals throughout the winter months. An environmental-based study in Pakistan discovered depressive mood throughout the extremes of summer and winter with a prevalence rate of 67%, with females (51%) outnumbering males (49%)<a href="#accordion">[1]</a>. Moreover, depressive disorders were more prevalent among people aged 41-60<a href="#accordion">[1]</a>. 
&nbsp;

The common treatments available for SAD are light therapy (phototherapy), psychotherapy, and medications like antidepressants. There is a growing body of evidence showing that light therapy can help with everyday depression. The use of light therapy in tropical countries like Pakistan has not been extensively researched. However, the presence of less severe side effects and the treatment&rsquo;s gentle nature makes its use worthwhile in Pakistan<a href="#accordion">[1]</a>. 
&nbsp;

On the basis of seasons, seasonal depression can be classified into two main categories:

<ol>
	<li>Summer Depression: It begins in late spring or early summer and continues till the autumn end. Sometimes, it is referred to as spring-onset.</li>
	<li>Winter Depression: This type of depression starts in fall or winter and ends in spring or early summer. 
	&nbsp;</li>
</ol>

Signs and Symptoms

The change in seasons brings with it a shift in people&rsquo;s biological internal clock or circadian rhythm. This in turn can lead them to be out of sync with their daily routine. The symptoms might make it difficult to perform regular tasks and can be distressing and overwhelming. Sign and symptoms of SAD include: 
&nbsp;

<ul>
	<li>&nbsp;Feeling down or sad for the most part of the day</li>
	<li>&nbsp;Anhedonia (lack of interest in activities you once enjoyed)</li>
	<li>&nbsp;Fatigue (indicates low energy levels)</li>
	<li>&nbsp;Weight gain (due to excessive cravings for carbohydrates and overeating)</li>
	<li>&nbsp;Struggle concentrating</li>
	<li>&nbsp;Decreased libido</li>
	<li>&nbsp;Feeling lethargic and sleepy during day time</li>
	<li>&nbsp;Low self-esteem</li>
	<li>&nbsp;Feeling of despair, irritability, guilt and worthlessness</li>
	<li>&nbsp;Less socially active 
	&nbsp;</li>
</ul>

However, summer depression has some distinctive features as enlisted below:

<ul>
	<li>&nbsp;Reduced appetite</li>
	<li>&nbsp;Disturbed sleep or trouble sleeping</li>
	<li>&nbsp;Weight loss 
	&nbsp;</li>
</ul>

Causes

SAD has been attributed to a biochemical imbalance in the brain caused by fewer daylight hours and less sunshine in the winter. Although the phenomenon is not completely understood, the theory states that due to a lack of sunlight, the hypothalamus eventually stops functioning, affecting the following<a href="#accordion">[2]</a>:

<ol>
	<li>Melatonin Hormone: Melatonin is a hormone that affects your sleep patterns and mood. A lack of sunlight can lead to an overproduction of melatonin, making you drowsy and sleepy. This is a usual condition faced by individuals suffering from SAD. 
	&nbsp;</li>
	<li>Serotonin Hormone: Serotonin contributes to the feeling of happiness and regulates appetite and sleep. A lack of sunshine may cause reduced serotonin levels, which are connected to depressive symptoms. 
	&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</li>
	<li>Circadian Rhythm: The body&rsquo;s biological clock, also called circadian rhythm, helps regulate hormones, sleep, and mood. As your body utilizes sunshine to time critical tasks such as waking up, reduced light levels throughout the winter may upset your biological clock and cause SAD symptoms. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/vitamin-d">Vitamin D </a>Deficiency: Vitamin D levels can boost the production of serotonin. Sunlight is responsible for producing vitamin D. However, in winter there is less sunlight, which leads to vitamin D deficiency. As a result, serotonin levels go down, and your mood is affected. 
	&nbsp;</li>
	<li>Pessimism: People suffering from SAD frequently experience stress, anxiety, and unpleasant feelings about the winter. The consequence of this seasonal depression is unclear. 
	&nbsp;</li>
</ol>

Diagnosis

Even after a comprehensive assessment, your health care provider or mental health professional may struggle to identify seasonal affective disorder since other forms of depression or mental health issues might cause similar symptoms. A complete analysis to help identify SAD often includes: 
&nbsp;

<ul>
	<li>Physical Evaluation: Your doctor may do a physical exam and ask detailed questions about your health. Depression may be connected to an underlying physical health condition in certain circumstances.</li>
	<li>Psychological Evaluation: Your health practitioner or psychological health expert will ask about your symptoms, thoughts, feelings, and behavior patterns to look for evidence of depression. You may help answer these questions by filling out a form.</li>
	<li>Blood Tests: Your doctor may also request blood tests to check your thyroid function, as low thyroid is sometimes the source of depressive symptoms. 
	&nbsp;</li>
</ul>

According to the National Institute of Mental Health (NIMH), the following criteria must be met for the diagnosis of SAD3.

<ul>
	<li>Symptoms of major depression are present</li>
	<li>Depressive episodes occur only during specific seasons for at least 2 consecutive years</li>
	<li>The seasonal episodes are more frequent than any other depressive episodes experienced by the person in their life 
	&nbsp;</li>
</ul>

Caution: Don&#39;t try to diagnose yourself if you experience symptoms of seasonal affective disorder (SAD). Consult your doctor for a complete evaluation. You might be depressed for another reason. Seasonal affective disorder is frequently part of a larger mental health problem. 
&nbsp;

Treatment

The treatment plan may include the following:

<ol>
	<li>Phototherapy: Light therapy has been a cornerstone in the treatment of SAD since the 1980s3.&nbsp;In phototherapy, the light box is placed a few feet away from the patient. This exposes the patient to bright light in the first half of the day for 15-30 minutes. The lightbox stimulates the brain chemicals called neurotransmitters which boosts the mood of depressed individuals. Normally ,it is considered as a first-line treatment due to limited side effects which include:&nbsp;&nbsp;</li>
</ol>

<ul>
	<li>Eyestrain</li>
	<li>Fatigue</li>
	<li>Headache</li>
	<li>Insomnia</li>
	<li>Irritability 
	&nbsp;</li>
</ul>

Note: In diabetics, light therapy can cause retinopathies. Therefore, caution is advised when treating SAD with phototherapy in such patients. 
&nbsp;

<ol start="2">
	<li>Psychotherapy: It is also referred to as talk therapy. Cognitive behavioral therapy, a kind of psychotherapy, has proven beneficial. According to research, it efficiently improves SAD and has the long-lasting benefits of any therapy technique. It involves training patients to replace their negative thought patterns with more positive thoughts. Moreover, individuals are encouraged to adopt healthy behaviors such as taking part in more outdoor activities. 
	&nbsp;</li>
	<li>Medication: Your doctor may advise you to begin antidepressant treatment before your symptoms generally appear each year. They may also advise you to continue taking the antidepressant after your symptoms have subsided. SAD can be treated with medications known as selective serotonin reuptake inhibitors (SSRIs) which are typically known as second-generation anti-depressants (SGA). These enhance mood by controlling the body&#39;s serotonin levels. Although the evidence to suggest they&#39;re effective in treating SAD is limited. 
	&nbsp;</li>
</ol>

If you are taking SSRIs, you should be aware that it may cause side effects such as

<ul>
	<li>Feeling agitated</li>
	<li>Shaky or anxious</li>
	<li>Diarrhea or constipation 
	&nbsp;</li>
</ul>

Caution: Inform your healthcare physician and mental health professional if you have bipolar disorder; this information is crucial when prescribing light therapy or an antidepressant. Both therapies have the potential to cause a manic episode. 
&nbsp;

Consider seasonal affective disorder indications and symptoms carefully. SAD, like other kinds of depression, can worsen and cause complications if not managed. These are some examples:

<ul>
	<li>Socially restrained</li>
	<li>Substance abuse</li>
	<li>Mental health disorder (<a href="https://merisehat.pk/disease/anxiety">anxiety </a>and eating disorders)</li>
	<li>Suicidal thoughts 
	&nbsp;</li>
</ul>

<ul>
	<li>Soaking daylight as much as possible, so that the levels of vitamin D and serotonin are well maintained.</li>
	<li>Healthy eating and consuming a low-carb diet might help in preventing SAD.</li>
	<li>Avoid spending too much time in isolation. Spending time with friends and family is a great way to lift your spirit. Keep yourself slightly indulged in activities.</li>
	<li>Don&rsquo;t stay cooped up in your home, instead enjoy the weather. Also, if you know you are affected during this season, always line up the activities beforehand to stay active and engaged.</li>
	<li>It&#39;s common to have low days. However, if you&#39;re feeling depressed for days at a time and can&#39;t get inspired to do things you generally prefer, consult your psychologist. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Seasonal depression also known as seasonal affective disorder (SAD), affects many people for a brief period of time, causing them to feel sad or uncharacteristic of themselves</li>
	<li>The feeling of sadness hits when the days get shorter and the nights get longer, which is the season of late fall and winter, and this is why it&#39;s called &quot;winter blues&quot;. It is a form of depression or mood disorder that takes place every year at the same time. However, there is a rare disorder termed &ldquo;summer depression&rdquo; which sets about in late spring or early summer and typically, ends in fall.</li>
	<li>The common treatments available for SAD are light therapy (phototherapy), psychotherapy, and medications like antidepressants. </li>
	<li>People suffer a shift in their biological internal clock or circadian rhythm when the seasons change, which can lead them to be out of sync with their daily routine. The symptoms might make it difficult to perform regular tasks and can be distressing and overwhelming.</li>
	<li>SAD has been attributed to a biochemical imbalance in the brain caused by fewer daylight hours and less sunshine in the winter. Though the phenomenon is not completely understood, the theory states that due to lack of sunlight, the hypothalamus eventually stops functioning.</li>
	<li>Even after a comprehensive assessment, your healthcare provider or mental health professional may struggle to identify seasonal affective disorder since other forms of depression or mental health issues might cause similar symptoms. A complete analysis is always needed to identify SAD.</li>
	<li>Consider seasonal affective disorder indications and symptoms carefully. SAD, like other kinds of depression, can worsen and cause complications if left untreated. 
	&nbsp;</li>
</ul>