Seasonal affective disorder can affect many. Check out some information and tips. (Getty Images)

9 things to know about Seasonal Affective Disorder

I have had the opportunity to live and practice medicine in multiple parts of the United States (US) including such Northern locations as Minnesota. One of the rationales as to why I ended up settling in predictably sunny Arizona has to do with how I noticed that my mood mirrored the 10-day projected weather forecast when sunny days lead to an uplifting feeling and cloudy days lead me to doldrums.

Although everyone’s mood may not mimic the weather outside, for 12 million Americans this issue does lead to a reversible depression otherwise known as Seasonal Affective Disorder (SAD). SAD is treatable depression that occurs at the same time every year with symptoms that sap one’s energy, making one feel moody or irritable.  The following are several tips which may help describe whether you have SAD and what you can do about it:

1.         SAD’s symptoms are seasonal.  They appear during late fall or early winter and go away during the sunnier days of spring and summer.  Some people with the opposite pattern have symptoms that begin in spring and summer.  In either case, symptoms start out mild and become more severe as the season progresses.    According to the DSM IV- the manual for psychiatric diagnoses, typical symptoms associated with fall and winter SAD include depression; anxiety; loss of energy; increased sleep; loss of interest in activity; appetite changes, especially craving for high carbohydrate foods with associated weight gain; and difficulty with concentration.  In contrast, spring and summer SAD symptoms include irritability, insomnia, agitation, weight loss and an increased sex drive.

2.         The exact cause of SAD remains unknown.  It is likely, as in many other conditions, that genetics, age, and the body’s natural chemistry –some studies have found a decrease in brain serotonin—a natural chemical– activity in patients with SAD.   Other factors have to do with a reduced level of sunlight in the fall and winter which may disrupt a body’s internal clock letting you know when you should be asleep or awake.  This disruption leads to depression.  In addition, a change in season can disrupt the balance of the natural brain hormone, melatonin, which plays a role in sleep patterns and mood.

3.         A few risk factors increasing one’s chance of having SAD are female gender and anyone living far north or south from the equator- the area on earth with maximal sun.   In the US, we see higher rates of SAD in New York (9.7%) versus Florida (1.4%). Family history also has an important role and those with SAD may be more likely to have it if they have relatives with the condition.

4.          Because SAD is a form of depression, its symptoms can worsen and lead to problems.  These problems can include suicidal thoughts or behavior, social withdrawal, problems at school or work, and substance abuse.  Treatment can help prevent these complications.

5.   Diagnosis of SAD is by a clinical examination by your physician with no special tests required for diagnosis.

6.  According to the Mayo Clinic, there are some simple lifestyle and home remedies that people can do to lessen the symptoms of SAD. These include:

  • Make your environment sunnier and brighter—let natural light into your home.
  •  Get outside, even on cold and cloudy days, outdoor light can help, especially if you spend some time outside within two hours of getting up in the morning.
  •  Exercise regularly.  Physical exercise relieves stress and anxiety, both of which can increase SAD symptoms.
  • Some dietary supplements may be helpful including melatonin and omega 3 fatty acids.   Dietary sources of omega-3 fatty acids include fish such as salmon, mackerel and herring and in certain nuts and grains.
  • Try other mood improving activities like acupuncture, yoga, meditation, massage or prayer.
  • Take a trip to some sunny, warm location.

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7.         Light therapy is typically a commonly suggested treatment for people if their symptoms are not severe and they have a history of response to light therapy in the past.  Typically, light therapy is delivered in twice daily 30- 45 minute sessions by the use of a specific light box with a person’s eyes open without staring directly into the source.   Benefits can be seen two – four days later.  Light therapy works because it mimics outdoor light and it causes a change in brain chemicals linked to mood.  If there is no response to light therapy and one feels suicidal thoughts, then one needs to seek medical attention immediately.

8.         There are some people with SAD who can benefit from specific antidepressants, particularly if the symptoms are severe.  Your doctor may recommend starting treatment with an antidepressant before your symptoms begin each year and beyond the time your symptoms normally go away.  It is important to remember that it takes several weeks to notice full benefits from an antidepressant.  In addition, you may need to try different medications before you find one that works well.

9.         Psychotherapy is another option to treat SAD as it can help identify and change negative thoughts and behavior that make you feel worse.  You can also learn healthier ways to cope with seasonal affective disorder and manage stress.

Regardless, of your choice of therapy, you need to stick to a consistent treatment plan, take care of yourself and socialize to avoid isolation.  There is no way to prevent the development of SAD, but you may be able to control it from getting worse over time.    If all else fails, you could always consider moving to a sunnier locale.

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Dr. Joseph Sirven is a first-generation Cuban-American. He is Professor and Chairman of the Department of Neurology and was past Director of Education for Mayo Clinic Arizona. He is editor-in-chief of epilepsy.com and has served U.S. and global governmental agencies including the Institute of Medicine, NASA, FAA, NIH and CDC.

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