Seasonal affective disorder (SAD)

Description

Seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons SAD begins and ends at about the same times every year. If you’re like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer. Seasonal affective disorder is a combination of biologic and mood disturbances with a seasonal pattern, typically occurring in the autumn and winter with remission in the spring or summer.

In a given year, about 5 percent of the U.S. population experiences seasonal affective disorder, with symptoms present for about 40 percent of the year. Although the condition is seasonally limited, patients may have significant impairment from the associated depressive symptoms. Treatment can improve these symptoms and also may be used as prophylaxis before the subsequent autumn and winter seasons.

Signs and symptoms of SAD may include:

SAD symptoms include low mood, lack of energy and increased sleeping and eating.
The most common pattern of SAD is depression in fall or winter with improved mood in the spring, but some people have the opposite pattern, with depression in the summer.

• Feeling depressed most of the day, nearly every day
• Losing interest in activities you once enjoyed
• Having low energy
• Having problems with sleeping
• Experiencing changes in your appetite or weight
• Feeling sluggish or agitated
• Having difficulty concentrating
• Feeling hopeless, worthless or guilty
• Having frequent thoughts of death or suicide
• Negative thoughts
• Fatigue
• Hypersomnia (Sleeping too much)
• Increased intake of carbohydrates/weight gain
• Social withdrawal/hibernating

Causes of SAD

The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include:

• Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body’s internal clock and lead to feelings of depression.

• Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.

• Melatonin levels. The change in season can disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood.

Diagnosis

To help diagnose SAD, your doctor or mental health professional may do a thorough evaluation, which generally includes:
• Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it’s functioning properly.
• Psychological evaluation. To check for signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You may fill out a questionnaire to help answer these questions.
• DSM-5. Your mental health professional may use the criteria for seasonal depressive episodes listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Prevention of SAD

• If you have a history of depression, bipolar disorder or suspect that you may be susceptible to it, maintaining a healthy and active lifestyle is helpful. Science has found exercise in particular helpful for easing symptoms of depression.
• Changing certain behaviors that exacerbate depression or SAD will reduce the chances of developing SAD [or] depression. For example, staying active despite lacking the motivation, exercising and eating healthy even when you are not hungry. It is also important to reach out for support.

Take care of your mental and physical health

Making an effort to get enough sleep, exercise regularly, stay hydrated and eat healthy, balanced meals will all support your overall health and mental health. Don’t be afraid to reach out to friends and family when you feel down. Emotional support, connection and a sense of community is important for helping you feel your best.

Try light therapy

Getting outside for at least 20 to 30 minutes a day is ideal. But, if you don’t have a lot of sun where you live or your schedule keeps you indoors a lot, a light therapy device is a relatively inexpensive solution.

Treatment

Treatment for SAD may include light therapy (phototherapy), medications and psychotherapy.
• Don’t brush off that yearly feeling as simply a case of the “winter blues” or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.
• In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer.

Less commonly, people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.

Medications

Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.
An extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants also may commonly be used to treat SAD.
Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year

Psychotherapy

Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive behavioral therapy can help you:

• Identify and change negative thoughts and behaviors that may be making you feel worse

• Learn healthy ways to cope with SAD, especially with reducing avoidance behavior and scheduling activities.

Home remedies

Make your environment sunnier and brighter. Open blinds, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.

Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help — especially if you spend some time outside within two hours of getting up in the morning.

Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, too, which can lift your mood.

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