If your moods fluctuate with the seasons, you might be dealing with seasonal affective disorder (SAD). Seasonal mood swings are somewhat common, based on your likes and dislikes when it comes to weather.
But some people experience symptoms more like mental health conditions in late fall or early winter … Which is more like clinical depression and less like a mild annoyance. The team at Neuralia TMS has put together this article to help you understand seasonal affective disorder and offer guidance on how you can get treatment.
What is Seasonal Affective Disorder (SAD)?
Seasonal affective disorder (SAD) is a type of depression that happens at specific times of the year, usually during the autumn and winter months when daylight hours are shorter. This condition is characterised by a variety of symptoms, including persistent low mood, lack of energy, sleep problems, changes in appetite, and difficulty concentrating.
SAD is more common in regions with long winter nights and limited daylight. In Australia, it may be less prevalent than in northern countries but still affects many people, especially those in the southern regions.
How does SAD Differ from Other Forms of Depression?
SAD isn’t like other forms of depression because of its seasonal pattern. While major depressive disorder (MDD) can occur at any time of the year, SAD symptoms typically show up during the late autumn and winter months and improve with the arrival of spring and summer. This seasonal variation is a key diagnostic feature for SAD.
Interestingly, for most people who have been diagnosed with SAD, the symptoms occur for 2 or more years in a row and are present for around 40% of the year. But that’s not true for everyone, as 40 to 50% of people who are diagnosed can end up skipping the period of depression every other year!
Signs and Symptoms of SAD
The symptoms of seasonal affective disorder can mimic depression or bipolar disorder. You don’t just feel sad (despite its name!). People with SAD experience a range of symptoms that are technically unrelated to the seasons, but are more similar to depression symptoms.
Common Symptoms Across All Types
SAD symptoms may change depending on which type a person has. It affects everyone slightly differently, but there are several common symptoms that people with SAD may experience regardless of the season:
- Persistent sad, anxious, or “empty” mood
- Loss of interest in activities
- Low energy and fatigue
- Difficulty concentrating
- Feelings of hopelessness, worthlessness, or guilt
Winter-Pattern SAD
Winter-pattern SAD, also known as winter depression, begins around late autumn and lasts until the early spring. The symptoms can be severe and debilitating. Here are the specific symptoms often associated with winter-pattern SAD:
- Oversleeping (hypersomnia)
- Overeating resulting in weight gain
- Craving carbohydrates
- Social withdrawal (wanting to “hibernate”)
People with winter-pattern SAD might find it hard to wake up in the morning, and may struggle with feelings of heaviness in their limbs. The craving for carbohydrate-rich foods can lead to weight gain, making their mood and energy levels feel even worse.
Summer-Pattern SAD
Summer-pattern SAD, or summer depression, is less common but can be just as challenging. It usually starts in late spring or early summer and eases up in the autumn. The symptoms are somewhat different from those of winter-pattern SAD, and include:
- Insomnia
- Poor appetite and weight loss
- Agitation and anxiety
Those with summer-pattern SAD may have trouble sleeping due to the increased daylight hours and higher temperatures. The lack of appetite can lead to weight loss, and the constant feeling of agitation can make it hard to relax and enjoy activities.
Causes of Seasonal Affective Disorder
Scientists are still unsure exactly what causes SAD, but it’s thought to be linked to reduced exposure to sunlight, which can affect our bodies in several ways. Here are some of the possibilities related to what causes SAD:
Impact of Lack of Sunlight on Circadian Rhythms
The lack of sunlight during shorter winter days can disrupt your body’s internal clock, or circadian rhythm. This clock regulates sleep-wake cycles, hormone release, and other bodily functions. When it’s dark outside, your body produces more melatonin, a hormone that promotes sleep. In those with SAD, this increase in melatonin can keep you feeling sleepy.
Also, less sunlight means lower levels of serotonin, a neurotransmitter that impacts mood. This combination of increased melatonin and decreased serotonin can lead to symptoms of depression.
Biological Factors
Numerous biological factors contribute to SAD. Genetics play a role, as those with a family history of depression are more susceptible. It’s also thought that people with SAD may have a deficiency in vitamin D, which is partly produced in the skin in response to sunlight. Vitamin D is essential for maintaining mood and overall health, and a deficiency can make depressive symptoms worse.
Environmental Factors
Reduced exposure to natural light, especially in the morning, can be a major cause of this condition. Seasonal affective disorder in Australia can be influenced by the fact that the intensity and duration of sunlight can vary greatly between regions and seasons.
Lifestyle factors also play a part; for example, individuals who spend a lot of time indoors or work in environments without much natural light are at higher risk. Shorter daylight hours during the winter can also limit outdoor activities and social interactions, which are important for mental well-being. In urban areas with tall buildings, light pollution and obstructed natural light can add to the issue.
Who is at Risk of Developing SAD?
Seasonal affective disorder can affect anyone, but certain groups are more likely to experience it. Understanding who’s at risk helps identify and manage the condition early.
Demographic Factors
Several demographic factors influence the likelihood of developing SAD:
- Age: SAD is more common in younger people (onset between 20 and 30 years). The risk decreases with age, but it can still affect older adults.
- Gender: Women are around 4 times more likely to be diagnosed with SAD than men! Research suggests that hormonal differences might play a role in this.
- Family History: Having a close relative with SAD or another type of depression increases the risk.
Geographic Location
The prevalence of SAD varies quite widely by location. People living in higher latitudes, where winter days are shorter and there’s less sunlight, are at greater risk. For example:
- Northern Europe and Canada: Higher rates of SAD are reported in these regions due to long, dark, cold winters.
- Australia: SAD is less common. But while Australia is known for its sunny climate, people in the southern parts, like Tasmania, may experience SAD during the shorter winter days. The variation in sunlight exposure across the country can impact the likelihood of developing SAD.
Pre-Existing Conditions
People with certain health conditions may be more at risk of developing SAD. These pre-existing conditions include:
- Mental Health Disorders: Those with a history of major depressive disorder, bipolar disorder, anxiety, and other mood disorders are more prone to SAD. The seasonal changes can make these conditions worse.
- Sleep Disorders: Problems with sleep, like insomnia or sleep phase disorders, can make a person more vulnerable to SAD. Disrupted sleep patterns affect mood and overall mental health.
- Vitamin D Deficiency: Lack of vitamin D, often due to insufficient sunlight exposure, is linked to SAD. People with low levels of this vitamin may experience more severe symptoms.
How is Seasonal Affective Disorder Diagnosed?
Several steps lead up to a SAD diagnosis. You’ll need to meet with a mental health professional, who’ll go through the following steps with you:
- Discussion: You’ll need to answer some questions about your symptoms. For seasonal depression to be diagnosed, your symptoms must happen during specific seasons for at least 2 consecutive years.
- Physical Exam: A thorough physical exam is conducted to rule out other medical conditions that could be causing the symptoms. This helps identify any underlying issues that might mimic SAD symptoms.
- Lab Tests: Lab tests like complete blood count (CBC) and thyroid function tests are often done. These also help to exclude other health conditions that can cause similar symptoms, such as hypothyroidism or anaemia.
- Psychological Evaluation: A psychological evaluation is key for diagnosing SAD. This includes detailed questionnaires to assess the severity, frequency, and patterns of symptoms.
- Seasonal Pattern Assessment Questionnaire (SPAQ): The SPAQ is a widely used self-reporting tool that helps identify the seasonal pattern of depressive episodes. Patients answer questions about their mood, energy levels, sleep patterns, and social activities throughout the year.
Treatment Options for SAD
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) is a non-invasive treatment that has shown promise for treating seasonal affective disorder. TMS involves using magnetic fields to stimulate nerve cells in the brain, specifically targeting areas associated with mood regulation.
Studies have shown that TMS can be effective for people with SAD, particularly if they haven’t responded well to other treatments such as medication or light therapy. Research indicates that TMS can lead to significant improvements in mood and overall functioning for many patients.
Light Therapy
Light therapy involves using a light box that mimics natural sunlight, usually providing 10,000 lux of light. This treatment is typically administered for about 20 to 60 minutes daily, ideally within the first hour of waking up.
Studies have shown that light therapy is effective in up to 85% of diagnosed cases, with an 80% response rate in selected patient populations. This method can significantly reduce symptoms by helping to regulate the body’s sleep-wake cycle and improve mood.
Medications
Medications are another treatment option for SAD, particularly antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline are often prescribed.
Another medication, extended-release bupropion (Wellbutrin XL), may help prevent depressive episodes. It’s important to note that these medications may take several weeks to show their full effects. Patients should work closely with their healthcare providers to monitor their progress and adjust dosages as needed.
Psychotherapy
Psychotherapy, specifically cognitive behavioural therapy (CBT) adapted for SAD (CBT-SAD), can be an effective treatment. CBT-SAD focuses on changing negative thought patterns and behaviours associated with depression.
It includes behavioural activation, which encourages patients to engage in enjoyable activities, improving mood and reducing depressive symptoms. This type of therapy can provide patients with tools to manage their symptoms and prevent future episodes.
Vitamin D Supplements
Vitamin D supplements might be helpful, especially if vitamin D deficiency is a known cause of someone’s SAD. Results have been inconsistent in the studies, but there have been some positive outcomes as well, so it may be worthwhile for some.
Lifestyle Changes
Daily Habits
Making daily lifestyle changes can greatly assist in managing SAD. Engaging in outdoor activities during daylight hours is very helpful. Another hugely beneficial change is establishing a regular sleeping and waking schedule. A regular physical activity and exercise routine is also a must, as exercise can boost mood and energy levels.
Environmental Changes
Creating a brighter and sunnier living space can positively impact those with SAD. Simple changes like opening curtains and using bright lights can make a difference. Dawn simulators, which gradually increase light in the morning to mimic sunrise, can help regulate sleep patterns and improve mood.
Stress Management Techniques
Managing stress effectively makes a huge difference to SAD symptoms. We are all different, so find techniques that work for you! For some people, meditation and practising mindfulness could help. For others, journaling could be a stress-relieving activity.
Engaging in social activities is also important to combat the withdrawal and estrangement often associated with depression. Staying connected with friends and family can give you emotional support and ease feelings of isolation.
Prevention and Minimising the Impact of SAD
Early Intervention Strategies
Seasonal affective disorder can be managed effectively with early intervention. Recognising the symptoms early – persistent low mood, loss of interest in everyday activities, irritability, and feelings of despair – means you can seek help as soon as possible.
Preparing for the Challenging Season
Preparation is key to coping with SAD symptoms. As the days shorten, start increasing your exposure to natural light during the day. Spending time outdoors, even on cloudy days, can help. At home, rearrange spaces to maximise sunlight.
If you are particularly vulnerable to SAD, start light therapy in early autumn to pre-empt the onset of symptoms. Plan a balanced diet rich in omega-3 fatty acids, vitamins B12 and D, and maintain regular exercise routines to support mental well-being. Proactively plan activities to stay connected with friends and family during tougher months.
Potential Complications of Untreated SAD
Impact on Mental Health
Untreated SAD can lead to serious mental health issues. Severe depression can increase the risk of suicidal thoughts and behaviours, while anxiety is also a common complication, worsening feelings of stress and hopelessness. Additionally, chronic sleep disturbances can cause even more severe mood swings and cognitive troubles. With this in mind, seeking early treatment can prevent your symptoms from descending into more dangerous ones.
Effect on Daily Functioning
SAD can severely affect daily functioning. Some may find it challenging to maintain regular work or school attendance, leading to decreased performance and productivity. Social withdrawal is common, as you may feel too exhausted or not interested in participating in activities they once enjoyed.
This isolation can strain personal relationships and create a cycle of loneliness and depression. The physical symptoms of SAD, such as fatigue and changes in appetite, can disrupt normal routines and overall quality of life.
Getting Help for SAD
Professional Resources
Getting professional help is essential to treat SAD and manage it. It won’t just go away on its own, in most cases! General practitioners can do initial assessments and refer you to mental health specialists if needed.
Psychologists and psychiatrists can offer therapies such as CBT and medication management. Light therapy devices are also available through healthcare providers, and they can guide patients on proper usage. In Australia, resources like Beyond Blue and the Black Dog Institute offer information and support services for those affected by SAD.
Support Systems
Building a strong support system can make a big difference in managing SAD. Friends and family play a much more important role than you (or they) realise, by providing emotional support and encouraging positive activities.
Joining support groups, either in-person or online, can connect people with others experiencing similar challenges, fostering a sense of community and shared understanding. Workplace accommodations, such as flexible hours or remote work options, can also help individuals cope with the symptoms of SAD. Community resources, including local mental health organisations and counselling services, are valuable for additional support.
Contact us if you’d like more details on SAD or TMS as a treatment for SAD. Our caring staff at Neuralia TMS are ready to help and answer all your questions.
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