Seasonal Affective Disorder: Why so SAD?

The time change can strike a blow to mental health

Love it or hate it, we all have to do it — here in America, we push our clocks back an hour to resume standard time shortly before Thanksgiving. But for those prone to seasonal affective disorder (SAD), the earlier sunset and longer period of darkness in the evening can also lead to a darkened mood that’s more than a momentary case of the blues.

What Causes SAD?
SAD is a depression triggered by a lack of sunlight, typically occurring in climates far north (or south) of the equator in the late fall and winter months. SAD affects about 5 percent of American adults during the fall and winter months, while another 10 to 20 percent can experience mild symptoms. The condition is four times more common in women than in men. The onset of SAD is usually between age 20 and 30 years of age.

Researchers have yet to uncover the specific cause for SAD. We do know that several factors are at play. Where you live matters: People in the northern United States and Canada experience SAD far more often than those who live in southern climates. Why does less sunlight place some people at risk? Shorter daylight hours are believed to be linked to biochemical changes in the brain.

One theory of SAD is that levels of melatonin (a hormone that regulates sleep and mood) are affected by reduced sunlight, and this knocks our circadian rhythm or “internal clock” out of sync. Another theory suggests that reduced levels of serotonin (a brain chemical that regulates your mood) leads to seasonal depression.

“If you experience loss of interest or depressed mood around the same time each year, you may be suffering from seasonal affective disorder,” says Michael B. Moore, MD, a board-certified psychiatrist at the Inova Behavioral Health Services Outpatient Center at the Merrifield Center location. “It is important to seek help, as there are effective treatment options available.”

Watch for These Symptoms
SAD symptoms can involve — you guessed it — a pervasive sense of sadness. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) the major symptom is a sad, depressed mood that is:

• Present most days and lasts most of the day
• Lasts for two or more weeks
• Impairs the person’s performance at work, at school or in social relationships.

The list of SAD symptoms is the same as a major depression. However, with SAD, these signs and symptoms appear and disappear at about the same time each year.

Other symptoms may include:

• Changes in appetite and weight
• Sleep problems
• Loss of interest in work, hobbies, people or sex
• Withdrawal from family members and friends
• Feeling useless, hopeless, excessively guilty, pessimistic or having low self-esteem
• Agitation or feeling slowed down
• Irritability
• Fatigue
• Trouble concentrating, remembering and making decisions
• Crying easily or feeling like crying but not being able to
• Thoughts of suicide (which should always be taken seriously)
• A loss of touch with reality, hearing voices (hallucinations) or having strange ideas (delusions).

Light the Way Forward

If you’re experiencing SAD, you shouldn’t just “live with it” until spring brings more daylight, because there are ways to improve your outlook dramatically in the meantime. While there is no one-size-fits-all treatment, there are a number of options to explore with your doctor.

Light Therapy
Because SAD is likely traceable to a lack of sunlight, replacing the sun’s effects through light therapy is a common treatment, and often the first one doctors recommend. Commercially available light boxes, which can be placed on a table or desk, allow you to read, eat, work, watch TV or do other quiet indoor activities while tackling SAD symptoms.

What should you look for in a light box? The intensity of each light box is measured in “lux,” or the amount of light it emits. For SAD, look for a 10,000-lux light box, which you should place between 16 and 24 inches away from your face for about 30 to 45 minutes. Don’t look straight at the box — the bright light can harm your eyes — but allow the light to enter your eyes indirectly, as you’re focusing on other things. Use the light box in the morning, as opposed to late afternoon or evening times, so that it doesn’t impact your sleep. Try to spend more time outside or near a window during the day as well.

If you’ve dealt with SAD in the past, it’s wise to begin light therapy around the time of year you typically begin to experience symptoms.

Medication
Antidepressants, either alone or along with light therapy, can also be used to treat SAD. Talk with your doctor to determine if a medication is indicated, and which medication would be right for you, as treatment is individualized. Patience is key. Keep in mind, it can take several weeks to feel the full effects.

Psychotherapy
For many people, wintertime can lead to decreased activity, social isolation and feelings of loneliness. A psychotherapist can help you identify patterns in negative thinking and behavior that impact depression, learn positive ways of coping with symptoms and institute relaxation techniques that can help you restore lost energy and lift your mood.

Complications
While light therapy and antidepressants can be effective treatments for SAD, they are not without risks, including the potential for manic episodes for those with bipolar disorder. Therefore, we recommend that you consult a physician prior to initiating treatment.

How Do I Know When to Get Help for SAD?
It’s never too late to seek treatment, even if you’re already experiencing symptoms of seasonal affective disorder. Seeking treatment can help prevent symptoms from becoming worse. You can schedule an appointment with your primary care physician or make an appointment with a mental health professional.

The bottom line? SAD is a serious but treatable condition. Please seek help if you think that you might be experiencing symptoms.

Learn more about Inova Behavioral Health Services, and find a list of locations. Call 703-289-7560 if you are in need of inpatient or outpatient adult mental health and substance use care, or adolescent inpatient services. For child and adolescent outpatient services, call 703-218-8500.

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