Seasonal Affective Disorder

The depression which is caused by changes in seasons is known as seasonal affective disorder (SAD). It begins and ends at the same time every year. Most often symptoms start to appear in the fall and continue to the winter, decreasing energy levels and bringing mood swings. 

Less often, SAD caused depression in the spring or early summer. Phototherapy, psychotherapy and certain medication such as anti-depressants can cure SAD. SAD must be given special attention and medical help should be sought and steps must be taken to keep the mood and motivation steady. 

This disorder should not be neglected as “winter blue” or “seasonal funk”. 

Symptoms of seasonal affective disorder vary depending on the season.

Seasonal affective disorder appears during late fall or early winter and disappear during spring and summer. However, some people may also develop these symptoms in the beginning of spring or summer. They can be mild in the beginning and become more severe as the season progresses. 

SAD is a subtype of major depression that comes and goes depending on seasons. Therefore, symptoms of SAD are similar to that of major depression which are as follows: 

• feeling of depression every day
• feeling hopeless or worthless
• feeling tired
• loss of interest in those activities which were once enjoyed
• sleep disorders
• improper appetite and changes in weight
• feeling lazy or agitated
• problems with concentration
• having no interest in life which leads to the development of frequent thoughts of death and suicide. 

Symptoms which are specific to winter-onset SAD are as follows: 

• irritability
• tiredness or low energy
• social problems, hypersensitivity to rejection
• heaviness in arms or legs
• oversleeping
• appetite changes (urge to eat carbohydrate-rich foods)
• weight gain. 

Symptoms of summer-onset SAD are as follows: 

• depression
• insomnia (problems with sleep)
• loss of weight
• loss of appetite
• agitation or anxiety. 

Bipolar changes associated with seasons usually are presented as mania in summer and spring and hypomania and depression in winter.

Although concrete cause of seasonal affective disorder (SAD) is not yet established, some factors which can influence it are as follows: 

• Circadian rhythm- Low levels of sunlight in autumn and winter may cause winter-onset SAD. This decrease of levels in the sunlight may disturb body’s biological clock and lead to depression. 
• Hormone levels- Serotonin, a neurotransmitter, commonly known as hormone of happiness might play a role in SAD. 
• Sunlight induces the synthesis of serotonin and low levels of sunlight leads to decreased serotonin. Depression develops in the absence of serotonin. 
• Melatonin plays an important role in sleep patterns and mood. Changes in the season can disrupt the balance of melatonin levels.

To diagnose seasonal affective disorder (SAD), doctor or mental health provider will perform certain set of tests which will evaluate the mental condition of patient:

• Physical exam- The doctor may perform physical examination and ask in-depth question about health because health problems may lead to the development of SAD. 
• Laboratory test- Complete Blood Count (CBC) and checking hormonal levels (thyroid, serotonin, melatonin) is performed to eliminate possible similar situations. 
• Psychological evaluation- The doctor will ask certain questions about symptoms, thoughts, feelings and behavioral patterns which should be answered correctly in order to have proper diagnosis for effective treatment. 

The DSM-5 criteria is used for diagnosing depression with seasonal pattern includes having the following experiences for at least 2 years: depression which begins and ends during specific season every year, no episodes of depression in other seasons, seasons with depression are more than seasons without depression. 

The following treatment methods are used for seasonal affective disorder: 

• Light therapy- in this procedure, a special light therapy box is used which emits bright light mimicking natural outdoor light and appears to cause a change in the levels of neurotransmitter such as serotonin. Also known as Phototherapy, this is first-line treatment for autumn-onset SAD. The effects of light therapy show in few days to two weeks having less side-effects. Research on light therapy is limited but has significantly improved the lives of people suffering from SAD. 

• Medication- Anti-depressants medications are common treatment if the symptoms are severe. Drugs such as Bupropion (Wellbutrin XL, Aplenzin) may help to prevent depressive episodes in people with history of SAD. Apart from these medicines, other anti-depressants are also used. 
• The doctor may recommend starting treatment with anti-depressant before symptoms typically begin each year. He or she may also recommend to continue the course of medication even after the symptoms fade away. Anti-depressants take several weeks to show their effects. Due to long list of adverse effects caused by such medications, they should be taken only according to prescription and the course of medication must not be stopped abruptly. 
• Psychotherapy- Also called as talk therapy, is another way to treat SAD. Psychotherapy can help to identify and change negative thoughts and behavior and learn healthy ways to cope with SAD. Finally it helps to manage stress due to SAD. 

There are no known ways to prevent the development of seasonal affective disorder but some steps can be taken to reduce the severity of the symptoms like:

• beginning treatment before the appearance of symptoms,
• continuing the treatment after the symptoms go away,
• doing meditation and yoga and getting enough sleep. 

It is very important to follow a regular pattern of sleep and eat to maintain the biological clock. 

Alternative remedies for seasonal affective disorder may not be enough to provide relief and some alternative therapies may not be safe. Some of them include: 

• Supplements- St. John’s wort which is not approved by Food and Drug Administration to treat depression in United States but it is popular in Europe. It can cure mild to moderate depression. This herb must be used with caution because it can interfere with a number of medications including anti-depressants, HIV/AIDS medication, immunosuppressant, birth contraceptives and lipid lowering agents. 

• SAMe- it is an artificial supplement of S-adenosyl-l-methionine. It is also not approved to be used in United States but are used in Europe as prescription drug to treat depression. 
• Melatonin- It is a synthetic form of naturally occurring hormone in the human body that helps to regulate mood and its consumption helps to decrease the symptoms of winter-onset SAD. But further investigations are required to prove its safety in children and for long term usage. 
• Omega-3 fatty acids- Usually found in cold water fish, flax seed, flax oil, walnuts and some other foods can be used to treat depression. Omega-3 fatty acids are considered to be safe in low doses but can interact with some other medications if taken in high doses. 
• Mind and Body therapies- Acupuncture, yoga, meditation, guided imagery, massage therapy can reduce the symptoms of SAD.

Some lifestyle changes are required for seasonal affective disorder to lead a happy and healthy life. Some of them include: exercising regularly which will help in maintain the hormonal levels by increasing the blood flow to brain, going outside and soak sunlight, eating lunch in a nearby park rather than in a closed place, avoid stress and follow regular sleep pattern.

It is important to be punctual to sleep since this will affect the biological clock. To cope with the situation of SAD, it is important to talk within the family or a counselor who can help improve the situation. 

Also it is essential for the patient to know that he or she is not the only person, there are many other people suffering from this disorder.

Factors that may increase the risk of seasonal affective disorder are as follows: 

• Gender- Most often, females are victims of SAD but men have more severe symptoms. 
• Age- Older people are more resistant to winter SAD than younger people. 
• Family history- SAD can be familial. People from the same family tend to share this disorder. 
• Bipolar disorder- people with bipolar disorder (people having mania and depression alternatively) are more predisposed to develop the symptoms of SAD. 
• Place of living- people who live in north pole or south pole far from equator can develop SAD because of decreased sunlight during winter and longer days in summer.

Signs and symptoms must be taken seriously otherwise it may lead to suicidal thoughts, social withdrawal, problems in school life and career or substance abuse.