Autumn in Wisconsin brings with it a bounty of color, crisp cool air, bright sunny days with cerulean cloudless skies, and the much-anticipated pumpkin lattes. However, while many are turtleneck-loving Fall enthusiasts, others dread the beginning of Autumn due to Seasonal Affective Disorder (SAD) and its less intense cousin subsyndromal SAD, also known as the winter blues. The further north from the equator is directly linked to an increase in SAD diagnosis.
Seasonal Affective Disorder is not considered a unique diagnostic entity. Rather, it is categorized under Major Depressive Disorder with a seasonal component. While most cases of SAD are brought on by the winter, it is possible to experience symptoms in the summer months as well. The most common symptoms of winter SAD include the apt acronym: a sad mood, lack of motivation, desire to withdraw from social situations, lethargy, sleepiness, irritability, and difficulty concentrating. Another hallmark symptom of Seasonal Affective Disorder is craving sugars and carbohydrates. While these foods may temporarily lift one’s mood, they also result in undesirable winter weight gain. Conversely, those that deal with summer SAD often exhibit a loss of appetite, unintended weight loss, agitation, and anxiety. In rare circumstances, one can even exhibit violent behavior.
Currently, SAD affects women at a rate four times higher than men, often first developing between ages 18-30. However, no age group is excluded, and stress brought on by life circumstances may make one more prone to its hold. It is estimated there are more than three million US cases per year.
Seasonal Affective Disorder is now a widely accepted medical diagnosis that came to fruition like many medical discoveries: through a little bit of serendipity when the right person moved to the “wrong” state. In the 1980s, Dr. Norman Rosenthal relocated from South Africa to New York to continue his medical training. What Dr. Rosenthal did not anticipate was his decrease in productivity in the dark winter months of New York. Even more surprising was how his productivity improved independently as spring bloomed. This experience led Dr. Rosenthal to his collaboration at the NIH with Al Lewy and Tom Wehr, who were both already researching melatonin and light’s effect on circadian rhythms.
Thanks to this trio, SAD was officially recognized as a unique depressive disorder. Their groundbreaking work sparked the use of The Seasonal Pattern Assessment Questionnaire and clinical interventions we still use today. Dr. Rosenthal continues to be one of the leading researchers on SAD, and I highly recommend his website www.normanrosenthal.com for more detailed recommendations and resources. Among the resources on his site is poetry Rx which explores the power of our creative nature to cope with mental health struggles.
The good news for those with SAD is that early interventions can significantly help. Unfortunately, like the winter itself, SAD often creeps up slowly on those affected as fall transitions to winter. Therefore, take note and make some adjustments before the fallen leaves are replaced with the first heavy winter snow.
Light Box Therapy, Antidepressants, and cognitive behavioral therapy are the first-line treatments. Additionally, there are a variety of self-care tools one can implement to help lessen the severity of SAD.
To understand the treatments available, we can break down what causes the symptoms; SAD is most likely caused by decreased serotonin, altered melatonin levels, and imbalanced circadian rhythms. Moreover, light plays a critical role in balancing circadian rhythms based on both the production and depletion of melatonin. Since blue light from our electronic devices inhibits melatonin before bed, and SAD shows an increase in melatonin during the day, those who suffer from SAD often experience sleepiness during the day and difficulty falling asleep at night. One way to combat this is limiting blue light exposure, especially before bed. Another is investing in a pair of blue light-blocking glasses.
On the flip side let there be light; the correct light. Light box therapy has stood the test of time as a treatment therapy. Dr. Rosenthal, based on his research, recommends the Carex Day-Light Classic which can be found on Amazon. This is due to its size, angle, and Lux intensity. This particular light box angles down onto you to mimic natural sunlight. It is recommended to be used in the morning, working up to 30 minutes of exposure (not staring directly into the light), and use with caution for those with a diabetic condition due to retinopathy issues and bipolar disorder.
If light box therapy isn’t for you there are plenty of more subtle changes to increase light exposure. Get outside; even when it looks cloudy out it is important to get in nature. Set the mood in your home with extra candles (even the electric ones in the windows). If you don’t have a fireplace, many kinds of electric fireplaces can be found online to enhance your space.
Aside from these changes, it can be beneficial to maintain a balanced routine. Maintaining good sleeping habits is paramount. It is also important to maintain regular physical activity. One way to promote exercise is by focusing on enjoyable ways to move your body. Finally, be mindful that carbohydrate and sugar cravings are part of SAD; being aware that this is part of the disorder can help one to find alternative choices when the cravings hit. A cup of tea with honey may just be enough to take the edge off. Plan now on what you know brings you joy and get items on the calendar to have winter events to look forward to. A little planning can go a long way to help ease the winter blues.
Lastly, talk about it. This is my greatest advice; do not suffer silently because you are not alone. Those that love and care for you may know what is around the bend. Seasonal Affective Disorder is not something you must deal with every year. As more research is done, we have a better understanding and more treatment options. There is always hope when you have the right tools at hand; and when at our best we help each other suffer a little less.
In closing, SAD can severely impact one’s quality of life. Be sure to contact your primary care provider if you think you or someone you love suffers from these symptoms.
“Autumn whispered to the wind, I fall; but always rise again.” Angie Weiland-Crosby.
Dr. Heather Dreske, Naturopathic Doctor
Patient-centered health consultant. Contact firstname.lastname@example.org