Holidays and Mental Health: Blog Series Part 2
Are you feeling SAD? Seasonal Affective Disorder
By Jessica Anne Pressler LCSW
Halloween, Thanksgiving, Kwanza, Chanukah, Christmas, NewYear’s Eve, and Valentine’s Day are all holidays that fall during the autumn and winter seasons. For many, there are days to look forward to, to enjoy with friends and family, to get dressed up,and enjoy delicious food and traditions. However, for others because of chronic mental and physical illnesses and situational reasons like grief, people struggle to enjoy the holidays. And for others, they are faced with depressive symptoms in fall and winter for no apparent reason other than the seasons. This is called Seasonal Affective Disorder or Depressive Disorder with Seasonal Pattern.
What is Seasonal Affective Disorder? According to the Mayo clinic staff, in an article, from mayoclinic.org, “Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons-SAD begins and ends about the same time every year.” The symptoms are most common to begin late fall or early winter and end in the spring. But it can also occur in the Spring and Summer, ending in the fall. This pattern needs to occur at least two years to be considered SAD. SAD interferes with daily functioning and can be overwhelming.
It is still unclear what causes SAD, but certain risk factors are being considered, such as a person’s melatonin levels, serotonin levels, and circadian rhythm. According to the American Psychiatric Association, SAD “has been linked to a chemical imbalance in the brain prompted by shorter daylight hours andless sunlight in winter.
In the DSM-5-TR, Seasonal Affective Disorder is called: “Depressive Disorder with Seasonal Pattern: This specifier applies to recurrent major depressive disorder.
A. There has been a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and a particular time of the year (e.g., in the fall or winter.) Note: Do not include cases in which there is an obvious effect of seasonal related psychological stressors (e.g., regularly unemployed every winter.)
B. Full remissions also occur at a characteristic time of year (e.g., depression disappears in the spring.)
C. In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships defined above and no nonseasonal major depressive episodes have occurred during the same period.
D. Seasonal major depressive episodes (as described above) substantially outnumber the nonseasonal major depressive episodes that may have occurred over the individual lifetime.”
According to the DSM-5-TR, “The prevalence of winter-type seasonal pattern appears to vary with latitude, age, and sex. Prevalence increases with higher latitudes. Age is also a strong predictor of seasonality, with younger persons at higher risk for winter depressive episodes.
What are the symptoms of Seasonal Affective Disorder, SAD?
1. Depression occurs for a limited time at the same time each year. You need to have it at least two years to be considered SAD.
2. According to the Mayo Clinic staff, symptoms are sad mood most of the day, low or loss of energy, feeling listless, not enjoying activities you once enjoyed, suicidal ideation, feeling hopeless, worthless, guilty, low energy, difficulty concentrating, difficulty concentrating or making decisions, craving carbohydrates, overeating and weight gain, or poor appetite and weight loss and having problem sleeping too much or sleeping too little.
3. Fall and winter SAD symptoms: oversleeping, overeating and craving foods high in carbohydrates, weight gain, low energy, often tired.
4. Spring and summer SAD symptoms: insomnia, poor appetite, weight loss, anxiety, agitation, and irritability.
*SAD is diagnosed four times more in women than men.(According to OASH, office of Woman’s Health, U.S Department of Health and Human Services, January 31, 2019)
*5% of adults in U.S have experienced SAD, and it lasts 40 % of the year. (According to the American Psychiatric Association)
*SAD in the fall/winter is more common with people living more North, such as in Alaska or New England and, in most cases, begins in young adulthood. (According to the National Institute of Mental Health)
*Important to note; a person may use drugs and alcohol to self-medicate, and their behavior can affect their interpersonal relationships and employment. Also note If a person with SAD has been diagnosed with other mental disorders such as anxiety, depression, and bipolar disorder, there may be additional complications. Bipolar disorder: People with bipolar disorder are at increased risk of seasonal affective disorder. They may experience depression in fall and winter and mania or hypomania, anxiety and irritability in spring and summer.
There are effective evidence-based treatments and therapies used to treat SAD.
Some examples are light therapy, cognitive behavioral therapy,and medication or a combination of therapies. Please see a medical doctor, nurse, or mental health professional specializing in Depressive Disorder with seasonal patterns/Seasonal affective disorder. It is best to be proactive and start therapies before onset or as soon as symptoms begin. Although, symptoms will usually improve on their own when the season is over;symptoms will improve more quickly with treatment.
Light therapies: Often, a person is asked to sit in front of a light box (a bright light that filters out UV rays) every morning starting before or onset of symptoms for at least 20 minutes a day and continue treatment until the end of the season. Talk to a doctor before using. There may be risks if you have migraines or other medical conditions.
Increased exposure to sunlight, either going outside or sitting near a window, may help but talk to a doctor as increased exposure to UV rays can increase your chance of skin cancer.
Cognitive behavioral therapy: CBT focuses on a person’s thoughts and behavioral patterns that may sabotage feeling better. The client will learn to develop an awareness of their automatic thoughts, see their situation from a different perspective and gain clarity. The hope is that the clients will work on changing their dysfunctional thoughts and behaviors.
Medication: Antidepressants such as SSRIs are used to treat symptoms of SAD when they occur, and they are believed to “significantly enhance patients’ moods.” The FDA approved bupropion for seasonal affective disorder, in an extended-releaseform, to be given daily from the fall to early spring, hoping to prevent the recurrence of SAD episodes. According to APA, the only treatment for the prevention of SAD is bupropion.
Vitamin D: According to NIH, many people with SAD have vitamin D deficiency, so it is possible taking a supplement may improve symptoms. Mixed feelings about effectiveness currently.
According to Dr. Robert Shpiner, a sleep specialist, “One of the major distinguishing features of SAD which can differentiate it from other forms of depression is the profound dysfunction of the internal “clock”.
We all have internal clocks and rhythms which help regulate many of our daily functions such as alertness, appetite, mood, sleep, and temperature. This is referred to as our “circadian” (circa=around and dian= the day) cycles and help regulate functions above as well has hormonal cycles, insulin secretion, gut function-the list is extensive.
We are generally in sync with our internal clock: meaning the day/night cycle on the outside matches our own internal rhythms. This synchronization occurs on a daily basis and is dependent on sunlight exposure, and environmental cues such as timing and types of meals, activities (lunch breaks, etc.) The chemical basis for this internally involves melatonin secreted by the pineal gland and its effects on dopamine and serotonin receptors in our brain. The pineal gland is sensitive to light and appears to be the major “timekeeping” gland.
An example of how a mismatch between the external time and our internal time is jet lag: when we travel to a different time zone, the “outside” time becomes different than our “inside time” and the symptoms such as insomnia, fatigue, mood changes, appetite changes even depression can occur.
This mismatch between “outside” and “inside” clocks is chronically disrupted and seems to be an important part of the disturbance in SAD: with many of the clinical features of this form of depression matching form of “chronic jet lag.
Part of the focus of treatment is attempting to use bright lights and environmental cues of a regimented regular basis to try to realign the external and internal clocks.”
If you believe you could be suffering from Seasonal Affective Disorder, please seek help from a medical or mental health professional.
Resources:
1. National Suicide Prevention Lifeline: (24/7) 1-800-273-8255 or 988. You can call or text 988.
2. National De Prevencion Del Suicidio: (24/7) 1-888-628-9454
3. Crisis Text Line: Mental Health America: (24/7) Text MHA 741-741.
4. (Type namilexington.org ) NAMI has an excellent guild to help someone with Bipolar Disorder cope during holidays.
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Call or text 988, which is the National Suicide and Crisis Lifeline,
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