The SAD side of winter
It seems like the sun hasn’t been out for weeks.We’ve had bitter cold, we’ve had snow and we’ve had mild temperatures and rain, but very little sunshine has peeked through the gray clouds in the past month. If you’ve been feeling a bit ‘gray’ yourself lately and aren’t quite sure what’s wrong, you may be suffering from a condition known as Seasonal Affective Disorder (SAD).
According to area psychotherapist Jim Foley, M.S.W., L.I.S., SAD is a term that refers to a mood issue which is only worse during certain seasons, normally winter. However, when Foley meets an individual that seems to have a worsening of depression or other mood problems (irritability, melancholy, lack of interest or initiative) in the wintertime, he explores a few options before focusing right in on the possibility of the biologically-based SAD.
“First and most common, I want to know if there is something about that particular time of year which is stressful or depressing to think about or deal with or remember,” he explained. “For example, many people feel a surge in grief feelings during holiday events, which no longer include some lost loved ones. Some people feel a ‘Charlie Brown Syndrome’ around the holidays, feeling bad about a lack of friends or family closeness during a time of year which raises most people’s expectations about how much togetherness they should experience. Technically, the SAD diagnosis should apply only in cases when there are no changes in mood besides the seasonal one, and when the depression seems to be caused only by the season itself, not by stressors that happen to show up in that season such as illnesses, loss of employment, family tensions around the holidays, etc.”
Once a valid SAD diagnosis has been determined, individuals can be treated and helped. One thing that can help is sunlight. Foley said there is actually new research showing that lack of skin exposure to sunlight reduces vitamin D production in the body, which in turn can affect cognitive performance, mood and coping skills.
“For people who have the more physical version of this mood problem, not the response to seasonal stressors and memories, two different types of light exposure seem to be helpful: through the eyes and through the skin,” he said. “There is more evidence that for more people full spectrum or blue light entering the eyes is able to reset a positive mood. The mechanism of this effect is not clear, or may vary from person to person. In some people, full spectrum light exposure to the skin, triggering increased vitamin D production, may regulate mood, especially if there is a vitamin D deficiency. This may explain why some people have a summer depression that is not just due to circumstance. Increased use of sunscreens and time out of the hot sun may prevent the vitamin D production as well in the summertime.”
Foley believes the strategies used for alleviating seasonal mood problems should be based on each particular case and individual.
“My advice to someone who experiences wintertime depression two or more years in a row is to take care of your body habits, your emotional associations, and see a doctor if these first two steps are not enough,” Foley said. “For instance, make sure you are getting regular sleep and appropriate patterns of light exposure-- turn the lights low in the evening (to increase melatonin at the right time to induce good sleep) but keep bright light exposure, especially natural or full spectrum light, during much of the day. Also talk to a relative, friend, write in a journal, or talk with a therapist about what associations you have with this time of year, and whether you can make a change in your reactions to the season. This kind of change is easier said than done, involving not just insight but practice at building new associations. Because such work to change your mood is complex, and hard to do when you’re depressed, it makes sense to get the help of a therapist, the way you might get help from a physical therapist when you need to make some body changes.”
If you find little relief after trying the aforementioned techniques, there are medical options. According to Foley, medications that increase serotonin and adrenaline-related chemicals can be helpful for those suffering with SAD.
“Melatonin, the chemical which induces sleep, is produced when it gets dark,” Foley explained. “As a result, melatonin is present in higher levels in everyone during the wintertime, but even more so in some SAD sufferers. Melatonin also suppresses production of thyroid hormones, adrenaline, and the stress response hormone cortisol. This results in lower energy levels, which can feel like depression. What’s worse is that melatonin is made in part from serotonin, which helps to keep our mood from being depressed and keeps us ready for activity. This is why medications that increase serotonin and adrenaline-related chemicals are helpful in SAD.”
Some symptoms of SAD include: depression, with melancholy or suicidal thoughts; hopelessness; anxiety; loss of energy, daytime fatigue despite sleep and lack of activity; social withdrawal; oversleeping, difficulty waking up in the morning; loss of interest in activities you once enjoyed, lack of social and sexual interest and responsiveness; appetite changes, especially a craving for foods high in carbohydrates; weight gain or difficulty concentrating, completing tasks, and processing information (resembling ADHD, but only occurring with the mood problems).
Foley added that there are certain medical conditions that mimic SAD symptoms and sometimes this can cause a misdiagnosis.
“There are some medical conditions misdiagnosed as seasonal affective disorder and vice versa, including hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections,” he said. “There are screening questions, and in some cases tests, which a medical doctor can use to make these distinctions. What is essential is properly diagnosing the mood problem, which can have physical effects, and noticing the seasonal pattern. I personally believe it takes about three years to see a yearly pattern, although the label has been used for people with just two consecutive years of seasonal mood problems.”
If you truly are having issues that seem to be more dominant in the winter months, it may be a good idea to see a therapist and undergo a preliminary screening to determine if SAD may be impacting your mood and energy levels. If SAD is the culprit, there are various treatments such as psychotherapy, medications and even light therapy that may make a difference in the way you cope and feel during the winter months.
“Whatever you do, don’t feel ashamed about being depressed to the point that you’re shy about seeking help,” Foley added. “Don’t give in to the urge to hibernate to the point of self-isolation, either. This may reinforce the depression. Depression happens, especially in winter, and it’s healthy to do something about it, healthy to talk to someone and healthy to ask for help.”