As the weather changes, we can find itself looking forward to pumpkin patches, fall-themed drinks, holiday music, and (blessed) escape from the heat that summer brings. As soon as Starbucks begins to roll out the Pumpkin Spiced Lattes, many begin breaking out the halloween decorations and holiday sweaters. And one stiff breeze is all it takes for social media to crank out memes related to the adjusting temperatures.
Recently, however, a few viral posts have lamented the upcoming return of “seasonal depression” with the changing forecasts. It begs the question: Is “seasonal depression” a real and diagnosable disease?
The short answer? Yes.
Known as “Seasonal Affective Disorder” (or SAD for short), Mayo Clinic defines it as “a type of depression that’s related to changes in the seasons — SAD begins at about the same time every year.” Rather than it’s own unique diagnosis, it is a subtype tied to major depression or bipolar disorder. And it is a very real medical condition in the same way that other mental illnesses are.
Dr. Daisy Nie, a clinical psychologist at Loyola University Chicago, explains that because it is a disease that occurs within the brain, unlike an external wound that can easily be examined by the human eye, it can be hard for people to understand. “What we do know,” she said, “Is that it’s not something that people can just tuck up and be strong about. They’re very real chemical changes.” And according to her, seasonal affective disorder effects somewhere between .5-3% of people.
The main difference between SAD and major depressive disorder is the timing of the pattern of episodes. Individuals living with seasonal affective disorder may experience a few depressive episodes throughout the year, but most of the episodes will noticeably occur within a seasonal trend.
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When the weather turns cold it is natural for the human body to undergo some adjustments. And as people are unable to go out as much and expose themselves to natural sunlight, changes in mood are also normal. Nevertheless, it is important to distinguish between someone who is being affected by the seasons and a person who has a very legitimate illness, such as seasonal affective disorder, that comes with symptoms and may need treatment.
Interestingly enough, a small subset of the population experiences SAD during the months of spring and early summer. “We do tend to talk about the one in the winter more, because it’s much more common for people to notice their mood change in the fall and early winter, and then naturally get better, if they don’t treat it, in the spring,” explained Dr. Nie.
While exact causes are not known, research has found possible answers within the human biology. The biological clocks that keep our bodies running on a daily schedule and govern our metabolism, brain activity, sleep patterns, body temperatures, etc., are know as our circadian rhythms. They are naturally occuring physiological changes that vary over a 24-hour-cycle. People living with SAD experience major disruptions to their natural circadian rhythms linked to decreased exposure to natural daylight and later dawns.
Beyond circadian rhythms, The National Institute for Mental Health found that the diminished sun exposure can also lead to lower levels of serotonin: one of the key mood regulating chemicals in the brain. The hormone melatonin, which is the body’s sleep regulator, is also affected by the shorter days. “As winter days become shorter, melatonin production increases, leaving people with SAD to feel sleepier and more lethargic,” the NIMH’s website states.
All of this can lead to several symptoms of seasonal affective disorder, such as:
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Low moods
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Decreased interest in activities one previously found enjoyable
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Less energy
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Higher difficulty in concentrating
The differing seasons in which a person’s seasonal affective disorder can take place leads to some differing symptoms.
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Symptoms for SAD range on a scale, with some people living with severe cases that may lead to feelings of hopelessness, thoughts of suicide, and psychotic symptoms such as hallucinations, and others experiencing a very mild form that may not impact their functioning to a large degree, and others. Dr. Nie stressed that sometimes there are forms that are subsyndromal: meaning, the severity level and frequency of symptoms don’t exactly meet levels of criteria that qualify an individual for having a major depressive disorder with seasonal patterns, and that, she clarified, does not diminish the fact that it’s still a disease. To her, “It’s clinically significant in that someone is having enough changes in their mood or sleep or appetite or energy or one of those things,” and still urges those people to seek out treatment.
Those suffering from SAD may be impacted through:
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Difficulty getting up and going to class
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No energy or motivation to complete tasks or homework
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Isolating themselves and withdraw from relationships
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Decreasing desires to go out
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Urges to sleep all day
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Wanting to avoid going to work
But through all of the gloom presented in these realities, there is sunlight at the end of this tunnel. Seasonal affective disorder is not only treatable, but those treatments have high success rates. “One of the keys is being proactive about it, especially when it’s something that someone knows they experience,” said Dr. Nie. “There are the acute ways to treat it and then there are the ways to try and prevent it.”
Treatment options include antidepressants, such as Prozac, Zoloft, and Lexapro, which have been shown, through studies, to be effective for seasonal affective disorder. Medications may either be taken only during the season during which an individual experiences episodes, or throughout the year (depending on the discretion of each person’s doctor).
One of the most popular — and effective — treatment forms is light box therapy to counteract the changes to biological rhythms from decreased sun exposure. The process involves buying a light box at a 10,000lux intensity level. “Just to put that into perspective, on a cloudy day, you’re probably looking at a couple thousand lux. If you come out midday and there’s a bright afternoon sun, you’re looking at somewhere from 50,000-100,000lux,” said Dr. Nie. Amazon has options ranging from $39 to $99.
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It is recommended to use the box right after waking up, for around 30 minutes. Individuals should sit a comfortable distance away with the box in his or her periphery and avoid looking at it head-on. “You try to use it at the same time everyday. The goal is that you’re trying to wake up at the same time everyday and you’re trying to get light exposure at the same time everyday, which is going to help you deregulate your biological clock,” said Dr. Nie. She also clarified that for some people who need more exposure, it is acceptable to use in the early evening as well.
In an interview for Psychiatry MMC, a peer reviewed journal for Matrix Medical Communications, Dr. Norman Rosenthal stated that, “Sixty to 80 percent of SAD sufferers benefit from light therapy.” And Dr. Nie took it one step further by suggesting that light box therapy could also be beneficial to those not suffering from seasonal affective disorder, to help regulate natural sleep-wake cycles.
According to Dr. Nie, there’s also a role that therapy plays in acute treatment. She recommended cognitive behavior therapy, which is what is implemented in therapy sessions addressing depression. This form can be tailored to specifically fit seasonal affective disorder and involves coming in for one to two sessions a week over a period of a few months.
SAD can be a condition commonly felt with students. Some studies suggest this is due to “phase delay” in which teenagers begin to have biological changes that prompt them to fall asleep later and sleep longer in the morning. For students at Loyola, the Wellness Center has options for those seeking therapy. Dr. Nie elaborated, “The process would be to schedule an intake either by calling the front desk or making an online appointment through the Wellness Center website. Then you can get connected to psychiatry and/or therapy.”
Beyond acute forms, Dr. Nie pointed out several options for behavioral things that can be accomplished throughout the year, as preventative measures:
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Maintaining a consistent sleep-wake cycle
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Getting a lot of natural sunlight throughout the day
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Aerobic exercising and daily walks (even when it’s not sunny outside)
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Avoiding electronic screens about one to tour hours before going to bed, since the blue light emitted stimulates daylight to human bodies.
For those who suspect their friend might be living with seasonal affective disorder, Dr. Nie suggests gently bringing up observations and offering support. “If it’s something that the person has some awareness that they’re struggling with and they want to know more about it, you can always share articles with them or help them to see that it is a real condition and there is treatment for it.” Any of the article presented within this one can work, as well as this one from American Family Physician.org.
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It is a disservice to those suffering from seasonal affective disorder to write it off as ‘being moody’ or simply ‘winter blues’. Misconceptions can also make it hard for someone affected by it to recognize his or her illness and get treatment. “From studies that we’ve done, we can see that the brains of people who have seasonal affective disorder are very different from the brains of people who don’t,” said Dr. Nie. “This is an illness and it can be really impairing.” However, there are a variety of treatment options to both help curb the effects of current episodes and prevent future ones. People living with SAD do not have to suffer needlessly from it’s effects.
So as the weather changes and the sun begins to appear less and less, we can all remember to look out for our friends, and ourselves. While seasonal affective disorder doesn’t last forever, it doesn’t have to be soldiered through alone.