Monday Medical: Understanding seasonal affective disorder
December 24, 2018
If wintry months make you blue, you may be dealing with seasonal affective disorder.
With SAD, people experience periods of depression or mania that start and stop with the seasons. It's more common than you may expect, affecting an estimated 5 percent of American adults. But it can be treated.
Below, Dr. Michelle Jimerson, a family physician in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center, outlines what to know about SAD.
It's more than just feeling down
To be diagnosed with SAD, a patient must exhibit five symptoms of depression for at least two weeks. Those symptoms may include a depressed mood, a loss of pleasure or interest in normal activities, a change in appetite, a change in sleep patterns, fatigue, loss of energy, feelings of guilt and even suicidal thoughts.
People who suffer from SAD during winter months are more likely to crave sweet and starchy foods, gain weight and sleep more, which is different from typical depression. "Everybody experiences it a little bit differently," Jimerson said.
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Though SAD usually affects people during dark, wintry months, some people suffer from a summertime version of the disorder.
Causes are not clear
SAD may be a result of genetics, changes in melatonin production or disturbances in natural circadian rhythms due to seasonal shifts in light, among other factors.
"There's so much we don't know about why people are depressed," Jimerson said. "There may be a familial, genetic component, a social component, a chemical component."
The disorder usually strikes first when a patient is in their 20s or 30s. And once someone experiences SAD, they are more likely to experience it again the next year.
However, it may just last for a season. "Just because you have it this winter does not mean you'll have it next winter," Jimerson said.
As with most forms of depression or mood disorders, there are several options for treatment. Treatment may include medication, as well as artificial light therapy.
"One positive is that the use of medications can be seasonal," Jimerson said. "You can start them in the fall, then come off them in the spring when there's more light, and you're feeling better. There's literally light at the end of the tunnel."
Artificial light therapy, including bright light therapy and dawn simulation, is proven to have a positive impact. The upside of light therapy is that it doesn't have the side effects that medications may have. However, you do have to find time to use it. Some people use bright light therapy while they eat a meal or exercise indoors.
Cognitive behavioral therapy helps people identify triggers of the disorder and find ways to foster healthy habits, such as getting enough sleep, avoiding screens before bedtime and exercising regularly.
"People may feel everything is out of their control, but therapy can help people gain back some control," Jimerson said.
Using all three therapies together often works best.
Your primary care doctor is a good first stop
To determine whether SAD or other mental health issues are affecting you, check in with your primary care doctor. Most primary care physicians give patients a simple screening for depression that can help flag potential issues.
"We encourage people to come in every year for an annual physical," Jimerson said. "Sometimes, it's not until you're actually talking with a doctor that you realize something may not be quite right."
Remember it isn't your fault
While there is still stigma attached to mental health issues, Jimerson encourages patients to keep treatment in perspective.
"If you need thyroid hormone, we treat you," she said. "Similarly, if you have low levels of serotonin, which affects the mood, we can treat that as well. Sometimes, it helps people to remember that SAD has a chemical component. We look at it as a medical condition just like we would anything else."
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at email@example.com.