Lydia, age 32, never realized that there was a pattern to her depression. “The years just kind of blend together, I knew that I struggled with depression, but it would be on again and off again” she commented in our first appointment in mid- October. After some discussion it became clear that she was dealing with seasonal affective disorder, aka “the winter blues”. Seasonal Affective Disorder (SAD) is most commonly associated with the dark and cold months of fall and winter. However, some people experience this cyclical depression in summer as well. Some of us are sensitive to seasonal changes. In the winter, our bodies and minds feel like they want to “hibernate” and in the summer, the extreme heat and long days can lead to physical and emotional restlessness. Also, for those who have experienced loss or trauma at certain times of the year, the memories of these events can trigger SAD. One of my patient’s mother passed away in November and he would develop classic signs of SAD every year during this month.
The signs of SAD include hopelessness, isolation, fatigue, irritability, mood swings, hypersomnia (tendency to oversleep), feelings of heaviness in arms and legs, changes in appetite, including cravings sweets and starchy foods, and increased sensitivity to social rejection. These symptoms can vary by season as well. For those with summer SAD, they may feel more restless, have insomnia, more agitation, and a loss of appetite. Passive suicidal ideation may also be a concern for SAD. This occurs when a person contemplates suicide but does not have a clear plan or intent to kill themselves. One of my patients described it as “wishing I could go to sleep and not wake up”.
When looking at the root cause for SAD, it can be challenging. There are many theories behind why some people experience cyclical depression and others don’t. One theory proposes that the hormone melatonin is responsible for an increase in sleepiness and lethargy. The dark days of winter can cause our bodies to produce an abundance of melatonin. Some people may be more sensitive to melatonin and thus, experiencing more fatigue. Another theory suggests that people with SAD may produce less Vitamin D due to lack of sun exposure and this can cause many of their symptoms. Vitamin D is linked with serotonin production and a lack of serotonin is associated with depression. Finally, family history of SAD and living in areas further north have been associated with the development of seasonal blues.
One of my patients once said “If I know that I’m going to be depressed a certain time of the year, I should just grin and bear it”. Fortunately, there are treatments and “grinning and bearing it” is not the only option. Treatments for SAD include light therapy, Vitamin D supplementation, antidepressant medications, and psychotherapy. In addition, self-care activities, such as planning pleasurable trips during winter/summer months, exercising, and approaching the season with a positive attitude can be effective in combating SAD.
References
National Institute of Mental Health
Melrose, S. (2015). Seasonal affective disorder: an overview of assessment and treatment approaches. Depression research and treatment, 2015.