Dr Jamuna Rajeswaran & Ann Sarah Paul
“I am no different than the weather,
The planets or the trees;
For there do not always have to be reasons
For the seasons turning inside of me.”-Suzy Kassem
Did you know the rotation of earth around its axis and around the sun has an effect on your mood and behaviour? Many people go through short periods of time where they feel unlike their usual selves; they feel down when the days get shorter in the winter (known as winter blues) and begin to feel better during spring and summer as the daylight hours get longer. However, for some, these mood changes are more serious than a passing winter blues, affecting all aspects of their functioning.
Season affective disorder (SAD) is a mood disorder with depressive disorder with depressive symptoms that occur at a specific time of the year with full recovery at other times of the year. It is not a separate disorder but a subtype of mood disorder characterized by recurrent depressive episodes, occurring typically by the end of fall and beginning of winter (i.e., winter SAD). The brain chemicals that help maintain the body’s daily rhythm are disrupted in people with SAD causing difficulty in adjusting to the seasonal changes in day length which eventually results in sleep, mood and behavioural changes.
Patients with SAD may suffer from general symptoms of depression including:
• Diminished pleasure or interest in activities that they once enjoyed
• Feeling sluggish or agitated
• Loss of energy
• Feelings of worthlessness
• Excessive or inappropriate guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death
Symptoms such as pain is often the presenting complaint at visits to doctors. The majority of SAD patients report at least one of the “atypical” depressive symptoms associated with SAD which frequently precede the onset of each episode and are closely associated with the recurrence of the episodes.
The atypical symptoms exhibited are fatigue, hypersomnia, increased appetite and weight gain, although some patients report reduced appetite, insomnia and weight loss. The increased appetite is typified by carbohydrate craving for sugars and starches that is often described as uncontrollable. Binge type eating can occur, although purging behaviours are uncommon. The increased eating and reduced activity usually leads to significant weight gain. With initial winter episodespatients lose the weight during the summer months when their appetite returns to normal and they are more active. However, with increasing age it becomes more difficult to shed the winter weight gain and there is a gradual year round increase in weight.
Winter depressive episodes are mostly of mild to moderate severity. Patients with winter SAD seldom require hospitalization, have psychotic symptoms or are at risk of suicide. However, most patients do experience marked impairment of functioning at work and in their social relations. Studies show a lifetime prevalence of 0.5% to 2.4% in the general population. Of patients with major depression, 10% to 20% have a seasonal pattern of symptoms consistent with SAD.
Seasonal affective disorder (SAD) is more common in younger people and women. The following people are at a higher risk:
• People who have another comorbid mood disorder, such as major depressive disorder or bipolar disorder.
• People who have relatives with SAD or other forms of depression or mental health conditions, such as major depression or schizophrenia.
• People who live at latitudes far north or far south from the equator. There’s less sunlight during the winter at these latitudes.
• People who live in cloudy regions.
The Recommended Initial Treatment for SAD according to clinical guidelines is light therapy, antidepressantsmedications, cognitive behaviour therapy (CBT), and/or lifestyle interventions (e.g., increasing exercise and exposure to natural light), alone or in combination. Studies that compared light therapy with CBT had found both treatment to be equally effective; though light therapy may achieve faster symptom reduction, beneficial effects of CBT has shown to last longer over time. Mindfulness-based cognitive therapy (MBCT) another well-known relapse prevention program helps people at high risk of depression recurrence to learn the skills to stay well in the long term.
It may not be possible for you to prevent the first episode of SAD, but once your doctor has diagnosed you with seasonal depression, you can take steps to better manage it or even prevent it from coming back. Since the onset of SAD is predictable, people with a history of SAD might benefit from starting the above mentioned treatments early on. Some of the things they can consider are:
• Start using light therapy at the beginning of fall, before you feel SAD symptoms.
• Eating a well-balanced and healthy diet though your body might be craving for food rich in starch and carbohydrates. Ensure proper intake of vitamins and minerals to give you the energy you need
• Exercising for 30 minutes for at least three to four times in a week helps in relieving stress and anxiety, which can play a role in your SAD symptoms.
• Having a good support system helps you remain active, especially during winter months. Meet up with your friends regularly and partake in group activities.
• Consider seeing a mental health professional who is trained in CBT. This treatment is effective for seasonal affective disorder.
• Consult your doctor and consider medication if the symptoms are severe or if they persist even after other treatments. In some cases, taking medication before SAD begins can prevent further episodes.