Whoever wants to pursue the science of medicine in a direct manner
Must first investigate the seasons of the year and what occurs in them~ Hippocrates
The days are getting shorter and the sun appears to have taken a hiatus behind the thick darkness of rainy cloud cover. The lush green of summer is now withered and brown. The zest of summer fun is now tempered by the chilly temperatures. Cold and damp outside, many individuals may want to take refuge under the warmth of their comforters and curl up for a long nap…that may very well last until March.
What is Seasonal Affective Disorder (SAD)?
According to Dr. Norman Rosenthal in his book titled, “Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder 4th Edition,” 14 million people in America suffer from seasonality and 14% of these individuals experience a lesser version known as winter blues.
While people of all ages may experience SAD, it is four times more likely to occur in women and it can affect all areas of one’s life.
What are the Symptoms of SAD?
SAD has been referred to as an energy crisis. Symptoms include extreme fatigue and lack of motivation. Previously enjoyed activities seem arduous and people describe having to “drag themselves out of bed” each day. Basic daily activities of life such as bathing and dressing become larger than life tasks that seem daunting and insurmountable.
Increase in Carbohydrate Consumption
Many find that consuming simple carbohydrates provides energy. This result was observed in a study conducted by Dr. Rosenthal and his colleagues at NIMH where they offered individuals with SAD and those without SAD high carbohydrate meals and high protein meals and discovered that the people with SAD were energized by the carbohydrates.
However, individuals who did not have SAD described feeling fatigued after eating the carbohydrates. This difference in metabolizing carbohydrates may be related to a decrease in serotonin (a neurotransmitter related to mood function) or an over-production of insulin that appears to occur in people who experience SAD.
Decrease in Sleep
People with SAD experience disruptions in sleep patterns. They may sleep longer and have greater difficulty rising. This results in tardiness to work or school. Further, individuals with SAD do not feel rested even after a long night’s sleep.
Decreased Sex Drive
Individuals with SAD describe feeling a lack of interest in sexual intimacy or physical touch in general. This situation may be met with feelings of rejection by the person’s partner and may cause conflict in the relationship. Most people with SAD report that they just want to be left alone during this time.
John Doherty found in his study that examined cognitive changes during an episode of SAD, that there is a decrease in concentration, productivity, interest, creativity and overall difficulty in completing tasks. These changes were validated in a study by Connie Duncan at NIMH, who observed changes in brain-wave patterns of people with SAD. However, these patterns appeared to subside with light therapy or change in the season.
People report a significant change in mood with SAD. They describe feeling more depressed or anxious. It often results in a negative feedback loop that includes the person feeling “worthless” or “unlovable” and behaving in ways that alienate her from others resulting in isolation. This perpetuates the belief that she is unlovable. These feedback loops can be detrimental to personal and work relationships.
A person with SAD may experience all types of physical ailments. These may include headaches and a variety of muscle pains. An individual may experience flu-like symptoms for extended periods of time. The immune system appears to be compromised in persons with SAD and they may be more vulnerable to illness.
It is not uncommon for persons struggling with SAD to self-medicate by using drugs or alcohol to reduce the symptoms. However, research indicates that even a small amount of alcohol in a person who is depressed may exacerbate the symptoms even days after ingestion. Therefore, abstinence from alcohol and drugs is highly indicated when treating SAD.
What are Treatments for SAD?
According to Dr. Rosenthal, light therapy has been shown to be effective for many persons with SAD. Treatment includes exposure to light consistently for 20-90 minutes daily. Because it is believed that the light acts on the brain via the retina, it is important to expose the eyes to the light. However, it is not effective for all people.
Jon Kabat-Zinn, professor emeritus of medicine, is instrumental in bringing mindfulness practice to Western Medicine. Years of research at University of Massachusetts Mindfulness Based Stress Reduction Clinic find significant benefits to a mindfulness practice. These include the realization that sadness is a part of the emotional spectrum of human experience and we all experience sad moments in our lives.
Mindfulness allows one to live in the moment and make choices based on the present circumstance. This experience can be liberating. Further, a person may be able to identify and address negative cognition that perpetuate the depressive state.
Exercise and Diet
Research indicates that aerobic exercise not only burns calories but increases metabolism. People with SAD tend to have lower metabolism rates and aerobic exercise could be beneficial. However, it was also noted by researchers that a combination of light therapy and exercise tends to provide greater benefits than each modality individually. This combined with a low carbohydrate diet appears to help fend off the effects of carb cravings.
There are a variety of medications available to address depressive and anxious symptoms. Finding a psychiatrist who will listen and provide collaborative input is the first step. It may take time to identify the correct medication or dosage, therefore, identifying a doctor whom trust is established is key. Keeping a log can prove helpful as the individual navigates the new medication and monitors for side effects and therapeutic dosage.
Current literature is filled with recommendations regarding vitamin supplements. As with any treatment, a collaborative discussion with a primary physician should take place. However, Dr. Rosenthal recommends taking fish oil, calcium citrate, vitamin D3, and a multi-vitamin.
Talk therapy can be highly supportive. In particular, cognitive behavioral therapy (CBT) has been effective in helping individuals who experience SAD identify negative thoughts and beliefs that perpetuate depressive and anxious feelings. CBT provides practical tools to help empower the person, as well as offering supportive information to normalize symptoms.
The change of season can be overwhelming for many individuals. Loss of energy, libido, and motivation along with increase in depressive or anxious feelings can create havoc in a person’s personal and professional lives.
Cultivating a treatment plan will not only ease symptoms of SAD, it will provide the individual with a sense of agency in her recovery. Empowered with these tools, she can better navigate the challenges of seasonality and serve as a reminder that spring-time will come.
Winter window photo available from Shutterstock