Seasonal affective disorder (SAD)

Description

Seasonal affective disorder (SAD) is a type of depression that is related to changes in seasons — seasonal affective disorder (SAD) begins and ends on the same schedule every year. If you are like most people with SAD , your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel a bad mood. These symptoms often resolve during the spring and summer months. Less often, SAD causes depression in the spring or early summer and resolved during the fall or winter months.

Treatment for the disorder may include light therapy (phototherapy), psychotherapy and medications.

Do not brush 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.

Symptoms

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunniest 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.

The signs and symptoms of SAD may include:

  • Feeling listless, sad, or down the greater part of the day, nearly every day
  • Loss of interest in activities once enjoyed
  • With a little energy and a sense of slowness
  • Having problems with sleeping too much
  • Experience carbohydrate cravings, overeating and weight gain
  • Having difficulty concentrating
  • Feelings of hopelessness, worthlessness or guilt
  • Have thoughts of not wanting to live

The fall and winter SAD

The specific symptoms of winter-onset SAD , sometimes called winter depression, may include:

  • Sleeping too much.
  • Changes in appetite, especially a craving for foods high in carbohydrates
  • Weight gain
  • Tiredness or lack of energy

The spring and summer SAD

The specific symptoms of summer-onset seasonal affective disorder, sometimes known as summer depression, may include:

  • Sleep problems (insomnia)
  • Lack of appetite
  • Weight loss
  • Agitation or anxiety
  • Increased irritability

The seasonal changes and bipolar disorder

People who have bipolar disorder are at increased risk of seasonal affective disorder. In some people with bipolar disorder, episodes of mania may be linked to a specific station. For example, the spring and the summer can cause symptoms of mania or a less intense form of mania (hypomania), anxiety, agitation and irritability. They may also experience depression during the fall and winter months.

When to see a doctor

It is normal to have some days when you feel down. But if you feel for days at a time and you can't get motivated to do activities you normally enjoy, see your health care provider. This is especially important if your sleep patterns and appetite have changed, you turn to alcohol for comfort and relaxation, or you feel hopeless or think about suicide.

Causes

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

  • Your biological clock (circadian rhythm). The reduction in the level of sunlight in the 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.
  • The levels of serotonin. 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.
  • The levels of melatonin. The change in season can disrupt the balance of the body's level of melatonin, which plays an important role in sleep patterns and mood.

Risk factors

The seasonal affective disorder is diagnosed more often in women than in men. And SAD occurs more frequently in young adults than in older adults.

Factors that may increase the risk of seasonal affective disorder include:

  • The history of the family. People with SAD may be more likely to have blood relatives with SAD or another form of depression.
  • Having major depression or bipolar disorder. The symptoms of depression may worsen seasonally if you have one of these conditions.
  • Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.
  • Low level of vitamin D. a little vitamin D is produced in the skin when exposed to sunlight. Vitamin D can help to boost the activity of serotonin. Unless the light of the sun and don't get enough vitamin D from food and other sources may result in low levels of vitamin D in the body.

Complications

Take the signs and symptoms of seasonal affective disorder seriously. As with other types of depression, SAD can get worse and lead to problems if not treated. These may include:

  • Social Withdrawal
  • School or work problems
  • Substance abuse
  • Other mental health disorders such as anxiety or eating disorders
  • Suicidal thoughts or behavior

Prevention

There is no known way to prevent the development of seasonal affective disorder. However, if you take steps to control the symptoms, you may be able to prevent it from getting worse with time. You may be able to head serious changes in mood, appetite, and energy levels, as it can predict the time of year when these symptoms can begin. The treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get worse.

Some people find it helpful to begin treatment before symptoms typically begin in the fall or winter, and then continue treatment past the time the symptoms usually go away. Other people need ongoing treatment to prevent recurrence of the symptoms.

Seasonal affective disorder (SAD)

Diagnosis

Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health professional to diagnose seasonal affective disorder due to other types of depression or other mental health conditions that may cause similar symptoms.

To help diagnose seasonal affective disorder (SAD), a thorough evaluation usually includes:

  • Physical exam. Your health care provider 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.
  • The laboratory tests. For example, your doctor may do a blood test called a complete blood count (CBC), or test your thyroid to make sure it works correctly.
  • The psychological evaluation. To verify if there are signs of depression, your doctor or mental health professional asks about your symptoms, thoughts, feelings and behavior patterns. You can fill out a questionnaire to help answer these questions.

Treatment

Treatment for seasonal affective disorder may include light therapy, psychotherapy, and medications. If you have bipolar disorder, tell your health care provider and mental health professionals — this is very important to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Light therapy

In light therapy, also called phototherapy, you feel a few meters of a special light box so that you are exposed to bright light within the first hour of waking up each day. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

The light therapy is one of the first line treatments for the fall-start . It usually starts to work in a couple of days to a couple of weeks and it causes very few side effects. Research on light therapy is limited, but it seems to be effective for most of the people in the relief of symptoms.

Before you buy a light box, talk to your health care provider about the best for you, and to become familiar with the variety of features and options for you to buy a high quality product that is safe and effective. Also, ask about how and when to use the light box.

Psychotherapy

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

  • Learn healthy ways to cope with it , especially with the reduction of avoidance behavior and the programming of activities that are meaningful
  • Identify and change negative thoughts and behaviors that may be making you feel worse
  • Learn how to manage stress
  • Build in healthy behaviors, such as increasing physical activity and improving your sleep patterns

Drugs

Some people benefit from treatment with an antidepressant, especially if the symptoms are severe.

Extended-release version of the antidepressant bupropion (Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of . Other antidepressants may also be commonly used to treat .

Your health care provider can recommend the initiation of treatment with an antidepressant before your symptoms typically start in every year. He or she may also recommend that you continue taking the antidepressant beyond the time, your symptoms usually go away.

Keep in mind that it can take several weeks to notice the full benefits of an antidepressant. In addition, you may need to try several medications before you find one that works for you and has the least number of side effects.

Self-care

In addition to your plan of treatment for seasonal affective disorder:

  • Make your environment bright and sunny. Open the blinds, cut the branches of the trees that block out the light from the sun or to add skylights to your home. Sit closer to the windows lighted, while at home or in the office.
  • Exit to the street. 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 helps to relieve stress and anxiety, which can increase the symptoms. To be more in shape can make you feel better about yourself, too, which can lift your mood.
  • Normalize sleep patterns. Programming of reliable times to wake and go to bed each day. Especially for the fall-winter onset , reduce or eliminate naps and sleep too much.

Alternative medicine

Certain herbal remedies, supplements, or mind-body techniques are sometimes used to try to relieve the symptoms of depression, although it is not clear how the effectiveness of these treatments for seasonal affective disorder.

Herbal remedies and dietary supplements are not monitored by the Food and Drug Administration (FDA) in the same way that drugs are, so that can't always be sure what you're doing and if it is safe. Also, because some herbs and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider or pharmacist before taking any supplement.

Make sure you understand the risks and possible benefits if you are looking for an alternative or complementary therapy. When it comes to depression, alternative treatments are not a substitute for medical care.

Coping and support

These steps can help you manage your seasonal affective disorder:

  • Stick to your treatment plan. Follow your treatment plan and attend therapy appointments at the scheduled time.
  • Take care of yourself. Get enough sleep to help you feel rested, but be careful not to take too much out of the rest, because the symptoms often lead people to feel like hibernating. Participate in an exercise program, or participate in another form of regular physical activity. Make healthy choices for meals and snacks. Do not turn to alcohol or recreational drugs for relief.
  • The practice of stress management. Learn techniques to manage stress better. For example, you can try relaxation techniques such as yoga, tai chi, and meditation. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.
  • Socialize. When you feel bad, it can be difficult to be social. Make an effort to connect with people that you enjoy being around. They can offer support, a shoulder to cry on, or shared laughter to give it a little boost.
  • Take a tour. If possible, take a winter vacation in sunny, warm places if you have the winter or cold in the places if you have the summer .

Preparing for your appointment

You can start by seeing your health care provider or a mental health professional such as a psychiatrist or psychologist.

Here's some information to help you prepare for your appointment.

What you can do

Before your appointment, make a list of:

  • Your symptoms, such as feeling down, having a lack of energy, excessive sleepiness, and changes in appetite
  • The depression of the patterns, such as when the depression started and they seem to do it better or worse
  • Any other mental or physical health problems that you have — both can affect the mood
  • None of the main factors of stress or life changes you have had recently
  • All the drugs, vitamins, herbs, or other supplements you are taking, including the dosage
  • Questions to ask your health care provider or mental health professional

Some basic questions to ask may include:

  • Are my symptoms probably caused by , or could be due to something else?
  • What else could be causing or worsening the symptoms of depression?
  • What are the best treatment options?
  • Using a light box to help my symptoms?
  • Are there any restrictions that you must follow or steps I should take to help improve my mood?
  • You should see a psychiatrist, psychologist or other mental health professional?
  • The drugs are likely to improve my symptoms?
  • Is there a generic alternative to the medicine you're prescribing me?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

Your health care provider or mental health professional is likely to ask a series of questions, such as:

  • What are your symptoms?
  • When did you first start having symptoms?
  • The symptoms been continuous or occasional?
  • How to make your symptoms impact your daily activities?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you have any other physical or mental health?
  • Are you taking any medicines, supplements or herbal remedies?
  • Make use of alcohol or recreational drugs?
  • Do any of your blood relatives have or other mental health condition?

Your health care provider or mental health professional will ask more questions based on your responses, symptoms, and needs. Prepare and anticipate the questions will help you make the most of your appointment time.

Symptoms and treatment of Seasonal affective disorder (SAD)