Winter is “in full swing” the guarded trees have shed their blissful leaves, cold waves have showered the polluted air, and the sun plays hide and seek over the shoulders of dark clouds. But, what is perplexing during the winter is that “some people start behaving unearthly”. They experience mood swings, anxiety, discomfort, and other stressful thoughts.
But most of us connect these behavioral changes with the ongoing frequent changes in whether-in-winter- when light becomes scarce, days grow shorter and physical activities are reduced.
These excuses do not hold true when we give a more realistic and scientific perspective to the seasonal behavioral changes. The medical community has compelling evidence which suggests that these behavioral changes are due to a category of depression which is known as “Winter Depression” or “Seasonal Depressive Disorder (SAD)” or what in layman terms as “Winter Blues”.
This specific form of depression occurs due to a complex interplay between biological processes, psychological factors and the environment (discussed later).
Further, SAD tends to run in the family; there is at least one close family member who has a history of depression. The prevalence is also based on the proximity to the equator. People living farther from the equator who experience less daylight and long nights are more susceptible to this disorder.
A recent study from the University of Glasgow, United Kingdom’s have found that women are more prone to SAD than men and affect mostly adults. And about 10 to 20 percent of recurrent depression cases follow a seasonal pattern. If left untreated SAD may eventually land people in major depressive disorder (MDD).
Most people start to experience the symptoms (discussed below) during later autumn and continue through the winter. And, the prevalence of this condition is expected to be very high in places like ours, where apart from above mentioned factors, continuous unrest, political instability, poor health conditions, unhealthy lifestyle and traumatic stress aggravate the condition.
Some of the symptoms which qualify the SAD include:
- Losing interest in day-to-day activities
- Difficulty in concentrating and exhibiting mind wandering
- Tiredness and feeling heaviness in arms, legs and back
- Frequent oversleeping (specific to SAD)
- Cravings for food high in carbohydrates, which may lead to weight gain (weight loss is specific to SAD)
- Feeling hopeless, worthless and a sense of guilt
- Problems in maintaining healthy relationships
- Experiencing changes in appetite which may lead to overeating
If left untreated, these symptoms may worsen over the time and eventually the person may end up with the major depressive disorder (MDD).
The symptoms of a severe form of SAD include:
- Social isolation
- Work place and family problems
- Drug abuse, cigarette smoke, and other addictions
- Eating disorder
- Anxiety and agitation
- Frequent thoughts of hamming oneself or suicide
Changes in circadian clock, an imbalance in chemicals and hormones like serotonin and melanin are the major causes associated with SAD.
Circadian clock: The biological clock (circadian rhythm) plays a major role in mood regulation and normal physiological function. The circadian clock is set up in an organism from the time of birth to anticipate daily environmental changes.
Over the time species like humans learn to adjust with a day-night cycle and maintain their biological processes and behavior.
In places, which experience more robust seasonal changes, the circadian clock synchronizes accordingly. And to do this, a specific set of neurons have been discovered in the suprachiasmatic nucleus region (SCN) of the brain, which regulates circadian clock.
The SCN takes the information about the length of day and night and process that information in a manner to adjust the biological clock accordingly.
People who experience SAD, have changes in their SCN and their circadian clock may not be efficient to do the fine adjustments with changing seasons. Both genetic and environmental factors determine the functioning of the circadian clock.
Serotonin: Reduced exposure to sunlight causes imbalances in neurotransmitters like serotonin the levels of which are highly associated with SAD. Serotonin regulates emotions, sleep, appetite, social behavior, and is a mood-stabilizing chemical. People with normal levels of this neurochemical fell happier, more focused, calmer and emotionally more stable.
Whereas SAD patients experience reduced serotonin levels during the winter season which is one of the primary drivers of seasonal depression. Exposure to bright sunlight, regular physical activity, and a healthy diet are some of the ways to naturally boost serotonin levels.
Melatonin: Melatonin is a hormone that plays a role in sleep and mood regulation somewhat like serotonin. This hormone is made during the night and its levels are highly dependent on the duration of day-night, and exposure to sunlight.
Winter season, where the sunlight is not adequate, melatonin balance is perturbed and may drive mood changes and sleep deprivation in people with SAD. Light therapy and medication may help to boost the melatonin levels and reduce the symptoms in affected patients.
Light Therapy: People with SAD may alleviate the condition by boosting their exposure to sunlight that is by spending more time outdoors whenever there is still some sunlight. Light therapy is by far the most effective way to control the condition and works wonders when used in tandem with other treatment modalities as discussed below.
Besides, natural exposure to sunlight, there are ways people can lighten their living rooms by artificial means using light therapy devices. Some of these devices can be found online and they go by the name “Light Therapy Lamp”. Brighten the dark room will have an astounding outcome on the people with SAD, and the scientific findings highly support this treatment modality.
Psychotherapy: Psychotherapy is another effective way to treat seasonal depression. This is a mindfulness-based therapy which helps people to understand their emotions, behavior, thoughts, to regain self-control, and to develop problem-solving skills. Therapists may recommend different psychotherapy practices based on the severity of the symptom and the cause of the disease.
Usually, patients are made to explore their negative symptoms and find patterns which can be replaced with more positive thoughts. Most commonly followed psychotherapy practices which are recommended for SAD include: Mindfulness meditation (MM), Cognitive behavioral therapy (CBT), psychodynamic therapy, Dialectical behavioral therapy (DBT), and Interpersonal Therapy (IPT).
Medication: The last resort of treatment when the conditions are severing. People who are diagnosed with seasonal depression can take antidepressants, but only after proper consultation with a professional. The medication is effective for sizable patients, provided they- are properly diagnosed, follow the prescription, and complete the course.
Further, it takes several weeks before these medicines start showing effect, and patience is the key to avoid premature termination of the prescription.
Usually, a healthcare professional recommends medication along with other therapy modalities as discussed above. It is important to note that for most of the patient’s, the condition remains under control if they religiously follow the natural healing methods (discussed above), as the use of antidepressants may not always be a good idea pertaining to their side effects and limited target efficacy.
The above-mentioned treatment methods show highly promising results when followed along with regular physical activity, meditation, yoga therapy, spending more time outside, taking vacations in sunny climates and eating a healthy diet.
Stress related health issues have skyrocketed over the last three decades and this will take a toll on our future generation. If immediate safety majors are not taken, we are afraid that the time will fell short to deal with this catastrophe.
Be it anxiety, depression or any other mental health-related issue, the first step is to find the symptoms, consult trained professionals, and seek help from your friends, family, and community to overcome from these debilitating conditions. Places like ours, where the mental health is a big concern, “winter blues” is like add-in salt to injury.
There are not many places in the world which experience seasonal changes as robust as in our state, and it is one of the primary reasons that most of the people are not much aware of this life-threatening condition.
It is a moral responsibility of our scientific and medical community to educate people and spread awareness about this and other related mental health conditions so that a time will come when the “winters” will be “without blues”.
Author is an Assistant Professor at JamiaMilliaIslamia, New Delhi