Seasonal Affective Disorder (SAD)

The concept of Seasonal Affective Disorder (SAD), a type of depression which can be triggered by changes in environmental light levels, dates back to Hippocrates who wrote about the changes of seasons producing diseases; although he was considering mainly a change in temperature versus light exposure and levels of exposure. Seasonal Affective Disorder received more prominence and acceptance as a type of depression when Rosenthal et al published a paper describing a group of patients with winter depression, Seasonal Affective Disorder, in 1984.

One finding in Rosenthal's report was the benefit of light therapy in relieving patient's symptoms of winter depression sometimes labeled winter SAD. So how do we determine whether we have Seasonal Affective Disorder, the "winter blues," depression, or if we're just imagining symptoms? Is Seasonal Affective Disorder a real condition? If so, is it treated like other types of depression?

Seasonal Affective Disorder is not recognized in ICD-10 (International Classification of Diseases) as a specific disorder, but it is in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) as 'recurrent depressive episodes with a seasonal pattern.' Some psychiatrists disparage the existence of Seasonal Affective Disorder, either winter SAD or summer SAD, as a separate disorder and believe the fact depression occurs seasonally is irrelevant in terms of overall diagnosis and treatment. In other words, some professionals contend that the seasonal mood changes are merely part of the patient's overall depression, not a separate condition referred to as Seasonal Affective Disorder.

About 16 percent of Americans will experience a major depression sometime during their life. Annually, approximately 17 million American adults will suffer from some form of depression. Nearly a half million people in the United States may have winter depression and an additional 10 to 20 percent of the population experiencing mild SAD.

Most often Seasonal Affective Disorder is considered to impact individuals during the winter months (typically late fall through early spring), although about one tenth of SAD cases occur during the summer. This condition is sometimes referred to as reverse SAD. Summer SAD is probably a response to the heat and humidity, especially in climates with warmer weather. If you experience periods of depression that seem to run with seasonal changes during the year, winter or summer, you may actually suffer from Seasonal Affective Disorder.

The key to differentiating between Seasonal Affective Disorder and other types of depression is that the periods of depression alternate with periods of well-being and normal or even elevated moods during other seasons and are not related to obvious things that would make a certain season stressful. In a few rare cases, individuals may experience both winter depression and summer depression.

Symptoms of winter SAD typically begin around October and subside in the spring, usually in March or April. Some SAD sufferers begin noticing symptoms of depression as early as August with the depression continuing through May. Women are more likely than men to suffer from Seasonal Affective Disorder, with noticeable SAD symptoms generally beginning in their twenties. Men are being diagnosed with SAD more frequently and Seasonal Affective Disorder can also occur in children and adolescents, although SAD is unusual in that age group. For adults, the occurrence of Seasonal Affective Disorder decreases with age and those living in northern geographic regions more commonly suffer from winter SAD than those living in southern regions.

Those with Seasonal Affective Disorder displayed as summer depression may exhibit opposite symptoms from winter SAD sufferers. Some of the more common symptoms of Seasonal Affective Disorder that occurs during the summer include poor appetite, weight loss, insomnia, and manic periods. Both winter SAD and summer SAD sufferers can also experience other symptoms of depression such as lethargy (loss of energy) and physical ailments, such as headaches and other minor aches and pains.

Anxiety, feelings of guilt or hopelessness, difficulty concentrating, social withdrawal and loss of interest in activities you once enjoyed, including sex, are also symptoms of depression. Symptoms of winter Seasonal Affective Disorder can include craving sweets and carbohydrates, weight gain, oversleeping and daytime fatigue in addition to the usual features of depression.

SAD and other types of depression are sometimes misdiagnosed as other conditions with many similar symptoms such as hypothyroidism, hypoglycemia or mononucleosis. The most common characteristic of those suffering with winter SAD, however, is how they react to changes in environmental light. Those with winter SAD experience more severe depression during the colder months with less sunlight due to shorter days. Summer SAD sufferers exhibit mania and other symptoms during the warmer months and notice a decrease in symptoms during other seasons.

It is still unclear what causes Seasonal Affective Disorder but more than likely heredity (one or more members of your immediate family suffers from depression), age and the chemical makeup of your body make you more or less likely to suffer from SAD and other types of depression. For Seasonal Affective Disorder during the winter, the availability of sunlight is an obvious factor. Researchers believe that reduced exposure to sunlight may interfere with the circadian rhythms that regulate the body's internal clock, contributing to depression in some individuals, especially Seasonal Affective Disorder.

Other experts suggest that production of a sleep-related hormone, melatonin, which increases during longer winter nights, might contribute to symptoms of winter SAD. Since people who are depressed do have lower serotonin (a brain chemical that seems to be triggered by sunlight) levels than the general population, those with winter SAD could be depressed due to lower production of serotonin during months with less daylight.

Seasonal Affective Disorder cannot be cured. Like other types of depression, winter SAD and summer SAD can be effectively treated and controlled. For those undergoing treatment for SAD, light therapy, medication, psychotherapy or a combination of the three have proven very effective. Light therapy as a treatment for Seasonal Affective Disorder has relatively few side effects and is easy to administer. Several antidepressant medications have been found especially effective in treating SAD as well, especially winter SAD, however it takes time for the medications to reach appropriate levels in your system.

Response to light therapy in SAD sufferers typically occurs by the end of the first week and by no longer than the third week after treatment for the winter SAD commences. Almost 100% of those receiving light therapy for winter SAD notice a decrease in their depression and some experience complete relief. Light therapy needs to be done daily, ideally beginning before the onset of SAD symptoms in the fall and continuing through the spring. The minimum light therapy session for effective alleviation of winter depression symptoms is about 30 minutes per day.

The light used for light therapy, administered via a light box, is about 20 times brighter than a normal household light or about 10,000 lux. An alternative to a light box is a visor or free-standing desk lamp that can be used at work. These both deliver lower levels of light over an extended period of time. Perhaps the most "natural" method of receiving light therapy for winter SAD is the dawn-simulating alarm clock, which gradually increases in brightness over a period of 30 to 90 minutes prior to normal waking time. Tanning beds should never be used as a substitute for light therapy, as the light source in a tanning bed is high in UV rays, with can harm your skin and eyes.

Your health care provider may prescribe an antidepressant medication in place of or in addition to light therapy to adequately alleviate your symptoms of winter depression. About 70% of SAD sufferers taking antidepressants report decreased symptoms of depression with about 50 percent experiencing complete remission, though it can take several weeks to feel the full benefits of antidepressant medications. Some antidepressants that have been very effective in treating SAD are Paxil, Zoloft, Prozac and Effexor. The FDA approved Wellbutrin XL in 2006 for use in the prevention of depression in people with a history of SAD.

These suggestions may help you cope with winter or summer depression, and better manage your Seasonal Affective Disorder symptoms:

Mild Seasonal Affective Disorder, with symptoms that don't interfere with your daily living, can generally be managed by using the suggestions listed previously. You may even want to try using light therapy on your own. If your depression, including winter depression or summer depression, becomes more severe, if your sleep is disrupted or if you notice a change in your appetite it is important to seek medical advice. Seasonal Affective Disorder and other types of depression should not be taken lightly, and individuals should never assume they are "just imagining" their SAD symptoms.

Yes, Seasonal Affective Disorder is real. Sometimes the symptoms are mild and could be categorized as winter blues or winter blahs. SAD sufferers experience true depression requiring light therapy, medication and/or psychotherapy to help manage winter or summer depression. It is never wise to assume our symptoms are "in our heads." When symptoms interfere with normal daily life, seek medical advice.

- Increase light exposure in your home by opening blinds and trimming back tree branches that block sunlight; add skylights, if practicable.

- Continue or begin exercising on a regular basis. Exercise helps relieves stress, which can make SAD symptoms worse.

- Get outside as much as possible, especially on sunny days to elevate mood and ameliorate depression.

- Learn how to manage stress and find ways to relax.

-If possible, take a vacation to a warm, sunny location for winter SAD, or a cooler location for summer SAD (skiing, or a visit to Alaska).

Mild Seasonal Affective Disorder, with symptoms that don't interfere with your daily living, can generally be managed by using the suggestions listed previously. You may even want to try using light therapy on your own. If your depression, including winter depression or summer depression, becomes more severe, if your sleep is disrupted or if you notice a change in your appetite it is important to seek medical advice. Seasonal Affective Disorder and other types of depression should not be taken lightly, and individuals should never assume they are "just imagining" their SAD symptoms.

Yes, Seasonal Affective Disorder is real. Sometimes the symptoms are mild and could be categorized as winter blues or winter blahs. SAD sufferers experience true depression requiring light therapy, medication and/or psychotherapy to help manage winter or summer depression. It is never wise to assume our symptoms are "in our heads." When symptoms interfere with normal daily life, seek medical advice.