Has Falling into Winter Got You Down?

Does your mood change when the leaves change? Do you start feeling less motivated, listless, sad, or down? It may be more than just the winter blues. You may have a type of depression known as seasonal affective disorder, or SAD for short. This type of depression is related to the change in seasons and begins and ends around the same time of year. For most people, symptoms begin in the fall and continue through the winter months. Less often, SAD can cause depression in the spring or early summer and ends during the fall or winter months. For the purposes of this article, I will be focusing on the fall/winter SAD.

Symptoms

Symptoms of seasonal affective disorder usually last 3 - 5 months of the year and can include feeling sad, anxious, or having an "empty" mood most of the day, nearly every day, for at least 2 weeks. There may be feelings of hopelessness, pessimism, irritability, frustration, or restlessness. You may experience a loss of interest or pleasure in hobbies or activities. You may experience decreased energy, fatigue, or feeling slowed down. You could have difficulty concentrating, remembering, or making decisions. There could be changes in sleep or appetite or unplanned weight changes. There could even be thoughts of death or suicide or suicide attempts.

Causes

Researchers are still working toward finding what specifically causes seasonal affective disorder. Studies indicate that people with SAD have reduced levels of the brain chemical serotonin, which helps regulate mood. Research also indicates that sunlight affects the level of molecules that help maintain normal serotonin levels. Shorter daylight hours may lead to decreased serotonin levels in winter.

Another possible cause could be a vitamin D deficiency, which is believed to promote serotonin activity. Vitamin D is produced in the body when it is exposed to sunlight. Less sunlight means less of an opportunity for your body to produce vitamin D, so it may help to increase your vitamin D intake during the winter months through diet and/or supplements.

There have also been studies around altered levels of melatonin, which is important for maintaining the normal sleep/wake cycle. Both serotonin and melatonin help maintain the body's daily rhythm and are tied to the seasonal day/night cycle.

Risk Factors

Seasonal affective disorder is diagnosed more often in women than men. It occurs more frequently in younger adults than in older adults. Other factors that may increase your risk of SAD include:

• Family history - individuals with SAD may be more likely to have blood relatives with SAD or another form of depression.

• Having major depression or bipolar disorder - symptoms of depression may worsen seasonally if you have one of these conditions.

• Location - if you live further from the equator, SAD appears to be more common. This is due to decreased sunlight during the winter and longer days during the summer months.

• Low level of vitamin D - less sunlight and not getting enough vitamin D from foods and other sources may cause lower levels of vitamin D, which helps to boost serotonin activity.

When to see a doctor

It's normal to have some days where you feel down. But if you feel down for days at a time and can't get motivated to do activities you normally enjoy, see your healthcare provider. This is especially important if your sleep patterns and appetite have changed, if you turn to drugs or alcohol for comfort or relaxation, or if you are feeling hopeless or are thinking about suicide.

Treatment

There are four main categories of treatment for seasonal affective disorder. They are:

1. Psychotherapy

2. Light Therapy

3. Antidepressant medication

4. Vitamin D

Talk to your healthcare provider about the potential benefits and risks of different treatment options and which treatment is best for you. Here is a little information on each:

• Psychotherapy (also known as talk therapy or counseling) - this method can help people with SAD by teaching them new ways of thinking and behaving and changing habits that can contribute to depression. Cognitive behavioral therapy is a subtype of psychotherapy aimed at helping people learn to challenge and change unhelpful thoughts and behaviors to improve their depressive and anxious feelings. It also uses a process called behavioral activation, which helps people identify and schedule pleasant, engaging indoor or outdoor activities to offset the loss of interest they typically experience.

• Light therapy - this has been a staple since the 1980s in treating SAD. The purpose is to make up for the diminished natural sunlight in darker months. These are specific very bright lamps that filter out the damaging UV light. A person sits under or next to them for 30-45 minutes daily from fall until spring. I am ordering this light myself. A word of caution: people with certain eye diseases or taking certain medications that increase sensitivity to sunlight may need to use alternative treatments or use light therapy under medical supervision.

• Antidepressant medication - this can be useful alone or when used in combination with psychotherapy. These medications are not immediate. It takes about 4-8 weeks to see (or feel) results. It is important to allow the medication enough time to begin working. Note: you may have to try several medications to find the one that works best.

• Vitamin D - this may provide some relief from symptoms. Studies have shown mixed results with usage. Some studies have shown it to be as effective as light therapy, whereas others have shown no effect. Please note: vitamin D can interact with some medications. If you take other medications, check with your healthcare provider or pharmacist before adding supplements to your routine.

Prevention

There is no known way to prevent the development of seasonal affective disorder. However, if you take steps before its onset, you may be able to manage your symptoms and prevent them from growing worse over time. Treatment can help prevent complications, especially if treated before the symptoms get bad.

I am personally aware that I suffer from seasonal affective disorder. I have been diagnosed with both depression and anxiety, so I know that I am more likely to have SAD. I already take medication and participate in cognitive behavioral therapy. In the fall, I prepare myself mentally for the onset of SAD by being aware of it and recognizing the signs. I am kind and gentle to myself. I make sure to do small things every day that make me happy. I try to get in as much sunlight as I can. I get out and do something every weekend. (This Saturday, I went to an arts and crafts show with gourds. See my Facebook post for pictures of the amazing creations made with gourds!) I try my best not to get overly stressed by breaking chores down into smaller, more doable tasks. And I make sure I make time to rest and recharge.

So, if you get down in the dumps around fall and winter, don't just dismiss it as the winter blues. If you see a pattern each year, be sure to take extra care of yourself and, if needed, seek help. You do not have to suffer or go through this alone. If you are someone who struggles during this time of year, I'd love to hear about what helps you. If this article has touched a chord in you, let me know. Support is our best ally!