The days are shorter, colder, and darker. You just feel ‘off,’ not yourself, barely able to muster the gumption to get out of bed in the morning. Once up you plod through the winter’s day feeling irritable and hypersensitive. Craving comfort foods while wallowing in this dreary funk, you suddenly notice your clothes have become little tight. Great, you murmur to yourself—now not only are you sad and listless but overweight as well.
You did not imagining this. This condition, often referred to as the ‘winter blues’ has a real name: Seasonal affective disorder, also known by its appropriate acronym, SAD, affects about 5% of the U.S. population, and up to 10% in certain geographical regions. Statistically, the further from the equator one lives, the higher the risk for acquiring this subset of depression.
SAD is prevalent in the winter months, with the majority of those afflicted being women (80%). However, when a man is diagnosed with SAD, he will have more intense symptoms than a woman.
What Causes Seasonal Affective Disorder?
SAD occurs when the seasons change. Usually, symptoms appear in the fall and persist through the winter months until the arrival of spring. It is believed that the reduced level of sunlight during these months may affect an individual’s serotonin levels, one of the neurotransmitters that are associated with mood.
Melatonin, a sleep-related hormone produced in the brain at higher levels in the dark is thought to be linked to SAD as well. When days are shorter and darker, increased melatonin levels cause a disruption in an individual’s internal clock, contributing to oversleeping, feelings of fatigue, and lethargy.
Reduced levels of Vitamin D are also a result of diminished sunlight. This seasonal fluctuation of vitamin D levels in the body is normal, however with a vitamin D deficiency the symptoms of depression are exacerbated.
Symptoms of SAD
Seasonal affective disorder is under the depression spectrum, so its symptoms mimic those of a depressive illness, with the core distinction being that the symptoms dissipate once spring arrives and sunlight is more abundant. These symptoms may include:
- Feeling sad most of the day, nearly every day
- Low energy
- Loss of interest in activities once enjoyed
- Difficulty concentrating
- Sleep disturbance, usually a desire to oversleep
- Feelings of hopelessness
- Changes in appetite or weight
- Decreased interest in sex
- Feeling agitated or irritable
- Thoughts of suicide or death
- Heavy feeling in arms and legs
- Relationship difficulties
- Emotional hypersensitivity
To determine if an individual has SAD versus major depressive disorder (MDD), certain symptoms are identified. Particularly a craving for carbohydrates, an increase appetite overall, weight gain, and excessive sleepiness are symptoms associated with SAD. The symptoms may start out mild, but as the season progresses and sunlight dissipates the symptoms become more intense.
Treatments for SAD
Because SAD is most prevalent in the winter, it is directly linked to a lack of sunlight. Therefore, the first line of defense is light therapy, also called phototherapy. A special light therapy box mimics natural outdoor light and will help suppress the brain’s secretion of melatonin. Patients are prescribed 1.5-4 hours a day of exposure to the light therapy box, and can go about normal activities like reading, eating, etc. during treatment. Relief from symptoms usually occurs within a few days to two weeks. Patients are encouraged to get outdoors for 20 minutes per day for natural sunlight as well.
Antidepressants may be prescribed if the light therapy is not effective in relieving symptoms. Wellbutrin XL is the only drug cleared by the FDA for the treatment of SAD, however other antidepressants such as Paxil or Prozac are often used in the treatment of SAD, alone or in tandem with the light therapy.
Vitamin D supplements are also added to the treatment regimen for SAD if a deficiency is detected. Doses of 400-800 IU daily are prescribed for treating mood disorders associated with SAD.
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