Do the fall and winter months get you down? Do you feel sluggish, sad, irritable, unmotivated or just generally out of sorts around the same time each year? You may be suffering from seasonal depression, also known as Seasonal Affective Disorder (SAD).
- About 2 to 3% of Canadians will experience SAD in their lifetime
- 90% of those diagnosed are women
- Another 15% will experience a milder form of SAD that leaves them only slightly depressed
- Age of onset is typically between 20 and 30 years of age
- Prevalence amongst the 20 to 30 years of age is approximately 3 times higher than those of 60 years
- People in northern countries or cities are more likely to experience SAD than those who live close to the equator
Seasonal depression is a mood disorder that reoccurs each year at the same time. The essential feature of SAD
is the onset and remission of the depressive episodes. SAD typically begins in the fall or winter and ends around spring or early summer. Although far less common, some individuals experience “Summer Depression”, beginning in late spring or early summer and ending in the fall.
According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders 5th Edition), 5 or more of the following symptoms must be present in the past 2 weeks, representing a change in one’s ability to function. One of the symptoms must include either i) depressed mood or ii) loss of interest or pleasure in preferred activities;
- Depressed mood (sadness, emptiness, hopeless)
- Diminished interest or pleasure in preferred activities
- Significant weight loss (without dieting) or significant weight gain
- Insomnia or hypersomnia
- Psychomotor agitation or retardation (restlessness or being slowed down)
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Difficulties concentrating or making decisions
- Recurrent thoughts of death, or suicidal ideation with or without a plan
These symptoms must be present for most of the day, nearly every day for a period of at least 2 consecutive weeks. Symptoms often cause distress and may affect work, relationships and other important areas of one’s life. In cases which there exist seasonal related psychosocial stressors (being unemployed every winter, school schedule) SAD is not applicable. It is important to note, in children and adolescents, symptoms may differ and include irritable mood rather than sadness.
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WHAT CAUSES SAD?
1. Temperament: SAD often affects those with high levels of negative affectivity
2. Environment: Environmental triggers may include adverse childhood experiences, stressful life events
3. Genetics and Physiology Factors. These factors may include:
- hereditary factors increase the probability of major depressive episodes
- functional abnormalities in specific neural systems supporting emotional processing, reward seeking, and emotional regulation in adult
- lower levels of serotonin have been shown to be linked to depression
- melatonin, a sleep-related hormone secreted by the pineal gland in the brain. This hormone, which can affect sleep patterns and mood, is produced at increased levels in the dark. Therefore, when the days are shorter and darker the production of this hormone increases. This can result in some of the symptoms associated with seasonal depression.
- other non-mood disorders; substance abuse, personality disorders and anxiety are amongst the most common presenting depressive symptoms
Typical features of all depressive disorders include the presence of sadness, feeling empty, irritable mood, along with somatic and cognitive changes which may affect one’s capacity to function. Anxiety and the inability to tolerate stress are associated symptoms affecting work, social and general responsibilities. It is characterized by significant changes in expression of emotions, cognition and functioning. Individuals with SAD may isolate themselves, refuse invitations, not answer messages and avoid social situations. They may sleep longer hours or stay in bed. Other sleep disturbances include difficulties falling asleep or maintaining sleep leading to increased fatigue. However, staying in bed and/or isolating oneself will exacerbate symptoms and contribute to negative thinking patterns and sadness that prevails. A disinterest in physical contact and intimacy can affect close relationships as well.
As with any depressive episode, mood, patience, tolerance, memory, concentration and the willingness to engage in preferred activities becomes demanding. Relationships both personal and work related are equally challenging. There has come to be little gratification and fulfillment in life. The decline in the depressive symptoms tends to be gradual leading to drastic changes in behavior and an increase in negative thinking. People often question what they can do but tend to feel whatever they do, won’t make a difference and they therefore remain “stuck”.
Feeling trapped can develop into a familiar routine and a new set of patterns. Individuals with moderate to severe SAD may often choose to remain “stuck” as the thought of doing something different increases anxiety. There is a familiarity to the depressive symptoms that are often preferred, as feeling better has become foreign and therefore can be avoided. The severity of the depressive episode is categorized as either mild, moderate or severe. Mild symptoms may not be as apparent. However, even mild symptoms can affect an individual physically and emotionally where daily responsibilities become challenging. A severe depression can be debilitating. The severe depressive episode can result in difficulties attending to basic needs such as hygiene and grooming, or in extreme cases an individual suffering from SAD can become mute or catatonic.
- Cognitive Behavioral Therapy (CBT) has been proven to improve the quality of life for individuals with SAD.
Psychotherapy offers individuals the opportunity to channel both thoughts and behaviors in a manner, which
can decrease the intensity and duration of SAD.
- Phototherapy which suppresses the brain’s secretion of melatonin has shown to be effective. Patients undergo treatment in bright light with high intensity a couple of hours a day. They may carry on normal activities while undergoing treatment.
- Pharmacotherapy such as an antidepressant drug may prove effective in reducing or eliminating symptoms.
- Self-help (for mild SAD) activities such as regular exercise, a healthy diet, proper sleep habits, socializing, balanced thinking techniques, and managing stress have been proven to reduce symptoms of depression. Self-help strategies can also help along with treatment for moderate to severe symptoms.
SAD typically recurs around the same time each year. Thus, proactive, preventive measures can reduce the symptoms as well as their intensity and duration.
Some preventative measures may include:
- Commencing light therapy in the early fall
- Increasing the amount of light at home
- Incorporating stress management techniques such as increased exercise and meditation, spending more time outside, and when possible visiting climates with more sun.
When the depressive episode is treated effectively, the symptoms fully subside.
Canadian Mental Health Association http://www.cmha.ca.
Specifiers for depressive disorders: With seasonal pattern. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org.
Mental Health America http://www.mentalhealthamerica.net