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Coping With Seasonal Affective Disorder


Don't brush off that yearly depressed feeling as just a case of the "winter blues" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year by tackling Seasonal Affective Disorder head-on.

What is it?

Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons — SAD begins and ends at about the same times every year. Symptoms generally start in the fall and continue into the winter months, sapping your energy and making you feel moody. However, some people have reverse SAD where the summer months are the cause of depressed feelings.

The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include:

  • Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression.

  • Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.

  • Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.

How to know if you have it?

Seasonal affective disorder is a subtype of major depression that comes and goes based on seasons. So symptoms of major depression may be part of SAD, such as:

  • Feeling depressed most of the day, nearly every day

  • Feeling hopeless or worthless

  • Having low energy

  • Losing interest in activities you once enjoyed

  • Having problems with sleeping

  • Experiencing changes in your appetite or weight

  • Feeling sluggish or agitated

  • Having difficulty concentrating

  • Having frequent thoughts of death or suicide

Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:

  • Irritability

  • Tiredness or low energy

  • Problems getting along with other people

  • Hypersensitivity to rejection

  • Heavy, "lead" feeling in the arms or legs

  • Oversleeping

  • Appetite changes, especially a craving for foods high in carbohydrates

  • Weight gain

Factors that may increase your risk of seasonal affective disorder include:

  • Being female. SAD is diagnosed more often in women than in men, but men may have more-severe symptoms.

  • Age. Young people have a higher risk of winter SAD, and winter SAD is less likely to occur in older adults.

  • Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.

  • Having clinical depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.

  • Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.

For some people, symptoms may start out mild and become more severe as the season progresses.

It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or turn to alcohol for comfort or relaxation. Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, SAD can get worse and lead to problems if it's not treated. These can include suicidal thoughts or behavior, social withdrawal, school or work problems, and substance abuse.

Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad.

To help diagnose seasonal affective disorder, your doctor or mental health provider may do a thorough evaluation, which generally includes:

  • Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.

  • Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly.

  • Psychological evaluation. To check for signs of depression, your doctor or mental health provider asks about your symptoms, thoughts, feelings and behavior patterns. Your doctor may have you fill out a questionnaire to help answer these questions.

Keep in mind that even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health provider to diagnose SAD because other types of depression or other mental health conditions can cause similar symptoms.

What are your treatment options?

Traditional treatments for SAD may include light therapy (phototherapy), psychotherapy and medications.

In light therapy, also called phototherapy, you sit a few feet from a special light therapy box so that you're exposed to bright light. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

You sit in front of the light box for about 30 minutes a day. This will stimulate your body's circadian rhythms and suppress its natural release of melatonin. Most people find light therapy to be most effective if used when they first get up in the morning, according to researchers at the University of Michigan Depression Center in Ann Arbor.

Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to two weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.

Before you purchase a light therapy box, talk with your doctor about the best one for you, and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Keep in mind that your light box should have a smooth diffusing screen that filters out ultraviolet (UV) rays. UV rays are harmful to the eyes and skin, which is why tanning beds are not a suitable alternative for light boxes.

Conversely, dawn simulators can help some people with seasonal affective disorder. These devices are alarm clocks, but rather than waking you abruptly with loud music or beeping, they produce light that gradually increases in intensity, just like the sun. Different models of dawn simulators are available, but the best ones use full-spectrum light, which is closest to natural sunlight. Russian researchers found that dawn simulators were as effective as light therapy for people with mild SAD, according to a study published in 2015 in the Journal of Affective Disorders. Even if you don't have SAD, dawn simulators are a much more calming, natural way to wake up than to an annoying alarm.

Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.

An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD.

Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.

Psychotherapy, also called talk therapy, is another option to treat SAD. Psychotherapy can help you:

  • Identify and change negative thoughts and behaviors that may be making you feel worse

  • Learn healthy ways to cope with SAD

  • Learn how to manage stress

Is there anything else you can do?

In addition to your treatment plan for seasonal affective disorder, try the following:

  • Take care of yourself. Get enough rest and take time to relax, which can help alleviate symptoms of SAD.

  • Low levels of vitamin D were linked to SAD in research reported in 2014 in the journal Medical Hypotheses. And a study published in 2014 the journal Nutrients found that people who took vitamin D supplements saw significant improvement in their depression. If you live far from the equator, you should be supplementing with vitamin D, anyway.

  • Practice stress management. Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.

  • Socialize. When you're feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.

  • Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter SAD or to cooler locations if you have summer SAD.

  • Aromatherapy may also help those with seasonal disorder. The essential oils can influence the area of the brain that's responsible for controlling moods and the body's internal clock that influences sleep and appetite. You can add a few drops of essential oils to your bath at night to help you relax. Essential oils from the poplar tree in particular were found to help depressive disorders in a study published in 2015 in the Journal of Natural Medicines.

  • Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.

  • Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.

  • Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.

  • Eat a well-balanced diet with lots of fresh fruits and vegetables. Eating well helps support overall well-being.


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