SAD or Seasonal affective disorder, more commonly known as the “winter blues” is actually a depressive condition that affects normal individuals in the same time every year. Though SAD most often strikes during winter, it has also been known to occur in summer, in autumn, and in spring. According to the Diagnostic and Statistic Manual of Mental Disorders, this condition is not classified as a mood disorder but rather a specifier for major depression.
Symptoms
Common symptoms of this condition include morning sickness, difficulty in waking up in the morning, fatigue, oversleeping and overeating, cravings for carbohydrates, and lack of weight gain. Affected individuals may also show difficulty in concentrating and completing daily tasks and marked withdrawal from family and friends. Another common symptom noticed in affected individuals is that they do nt seem to enjoy anymore things or tasks that previously made them happy.
Those who are suffering from summer SAD (also known as summer and spring depression) exhibit the symptoms that are also associated with classic depression such as anxiety, insomnia, irritability, weight loss, and decreased appetite. Other symptoms include a decrease in libido and social withdrawal. Difficulty in coping with the warm temperatures of summer and spring is also another problem encountered by affected persons.
Diagnosis
SAD is not considered as a separate condition or disorder in itself, but as an additional description to the pattern of episodes related to major depression in people suffering from major depressive disorders and bipolar disorders.
SAD must meet the following criteria, including episodes of depression at a particular time of a year and remissions or hypomania at a certain time of a year. The patterns must be observed for or must have lasted 2 years. Additionally, these episodes of seasonal depression must outnumber other episodes of depression throughout the affected lifetime of the individual.
Causes
The widely accepted explanation is that SAD is caused by changes in the amount of sunlight present in the winter, when the days are shorter. Its origins have also been said to be an evolved adaptation in humans for surviving the winter cold, similar to the hibernation in bears and other mammals.
Experts think that the hormones melatonin and serotonin may be involved in SAD. These are the two hormones that regulate the sleep-wake cycles, energy, and mood of the body. The changes in the length of days during the fall and winter may trigger an increase in the levels of melatonin and decreased levels of serotonin, creating the perfect condition for depression.
Serotonin levels go up when the body is exposed to sunlight so it is more likely that serotonin levels are lower during the winter when there is less sunlight. Low levels of serotonin are associated with depression, while the increasing levels of serotonin combat depression.
Who gets SAD?
The condition often affects the moods of inhabitants of Nordic countries, except in Iceland, where there are very few cases of SAD. About 20% of Irish people are affected by SAD. Women are also more likely to be affected by the condition compared to men.
However, most people do not develop the condition even if they live where the days are shorter. Experts think that people who do get the condition are simply more sensitive to light changes. Those with relatives who have been diagnosed with the condition are also more prone to developing SAD.
Treatment
There are various kinds of treatment for seasonal affective disorder. These include medication, light therapy, cognitive behavioral therapy, and ionized air administration. The supplementation of melatonin, a hormone, has also been found to be quite a very effective form of treatment for this kind of mental condition.
Light therapy utilizes a light box, which emits brighter light compared to a regular incandescent bulb. Blue light therapy, which is a variation of the light therapy, is the most effective with the use of blue light. The patient sits about 30 to 60 cm. away from the box while he keeps his or her eyes open but is not staring at the source of the light. Dawn simulation is also another effective way treat SAD. Consistent time outside in the sun has also been found helpful.
Treatment with SSRIs, or selective serotonin reuptake inhibitors, have been shown effective as treatment for SAD. Antidepressants found to be effective include sertraline, paroxetine, or fluoxetine. Negative air ionization is another method used, which involves the release of charged particles into the sleeping environment.
Several modes of treatment can be used simultaneously with other treatments. Light therapy and Flouxetine have both been found to be highly effective (67% effectiveness) in treating people with SAD, based on the Can-SAD study in 2006, which involves head-to-head trials. Subjects who underwent light therapy showed early clinical improvement on the first week of the treatment. Modafinil is another treatment that is well-tolerated in patients with SAD.
Changes in diet may also help in the regulation of hormone levels. Patients are often told to avoid foods with simple sugars and instead focus on foods with complex carbohydrates. The diet should include whole grains, vegetables, and fruits.
Severe complications include the development of suicidal thoughts, difficulties in work and school, and substance abuse. However, this can be monitored and prevented with the right kind of treatment coupled with a good support network. The key is proper management of the symptoms until they disappear. Symptoms related to SAD should be identified early on to seek proper treatment at once and avoid severe complications that can lead to worse cases of depressive episodes.