SEASONAL AFFECTIVE DISORDER (SAD)
Beata D. Jankiewicz, LCPC, CADC, ATR
I can’t find the joy within my soul
It's just sadness taking hold
I want to come in from the cold
And make myself renewed again.
It takes strength to live this way
The same old madness every day
I want to kick these blues away
I want to learn to live again...
- Annie Lennox, “Dark Road”
For the fifth time, you push the snooze on the alarm and you muster all the energy within your body to open your eyes. Your eye lids feel heavy, but you are compelled to get up -- not out of enthusiasm to begin the day, but out of guilt that this will have been the third or so consecutive day you would have arrived to work late. Upon finally arriving to the office, you still feel exhausted and depleted of energy and focus which once powered your day with excitement and creativity. Going to bed earlier last night didn’t help, in fact you feel more tired. Later, friends ask if you want to catch that new movie or try out a new restaurant, but you decline, for no particular reason. Family calls to ask if you want to spend time with them, reminding you that it has been a long time since your last visit. You let the calls go to voicemail, with no intention of calling back. So you return home where you spend the rest of your evening on the couch, watching TV or playing video games and eating junk food. You look up at the calendar and sigh.
Yes, here it is again, that familiar feeling of gloom overpowering your winter season, year after year. If this story seems somewhat familiar, you may be like the thousands of individuals suffering with Seasonal Affective Disorder (SAD) with the coming of winter months.
SYMPTOMS:
An offshoot of Major Depression, Seasonal Affective Disorder (SAD) manifests itself as a mild depression with a predictable winter pattern, and is often left underdiagnosed despite its yearly appearance. In most places in the United States, symptoms present themselves between September through October, when the days become shorter and darker; trickling off around April or May, when sunshine becomes more available and the weather more welcoming. Initially, mostly mild forms of lethargy, forgetfulness and carb cravings, turn into more pronounced behaviors such as withdrawal from social activities and friends, an overall sense of worry and sadness, and an uncharacteristic decrease in abilities to deal with stress and daily routine. Typical symptoms of Seasonal Affective Disorder (SAD) may include:
· Difficulty waking up in the morning
· Tendency to oversleep
· Loss of energy, fatigue during the day
· Over-eating, especially carbohydrate foods
· Weight gain (due to loss of energy and increase in food consumption)
· Difficulty in concentration and task completion
· Withdrawal from friends, family, and social activities
· Decreased sex drive
· Depression mood, pessimism and guilt, feelings of hopelessness, unusual guilt
RISK FACTORS:
Since first identified and brought to public attention in the mid-80’s, Seasonal Affective Disorder (SAD) has raised interest of researchers and mental health practitioners worldwide. Nonetheless, despite fascination and research, causes of SAD remain enigmatic. According to SAD researcher, Barry Whitehead, 75% of individuals suffering with seasonal depressed mood are women. Initial onset appears between age 18-30, although both teenagers and senior citizens have been afflicted with SAD.” Genetic predisposition may have its role to play, however, is not nearly as important as geography. Individuals living in areas where there is a significant decrease in sunlight during the winter are more likely to develop SAD than individuals in generally more sunny areas.
SAD appears to be related to several biological and chemical systems in the human body. Some of these “chemicals” include the neurotransmitter serotonin, the hormone melatonin, and various vitamins. The amount of sunlight we are exposed to as well as our “internal clock’s” ability to sufficiently stabilize our sleep and rest patterns also are related to SAD. Further information about the causes of Seasonal Affective Disorder (SAD), are speculative and no one knows for sure how and why so many of us feel down during the winter time, however, most experts point to the sun.
MISDIAGNOSIS:
Many people afflicted with SAD are able to tolerate the condition and compensate with the sadness, melancholy or depression. It is important, however, to recognize this as a legitimate psychological and medical disorder. Because most people simply misidentify SAD as laziness, holiday blues or just “a bad day,” the condition is underdiagnosed and under reported. However, these symptoms should be heeded and not dismissed as easily as they may in fact be warning signs of more serious issues. As a relative of Major Depression, SAD may in fact be a precursor to a depressive episode and could pose risk of for a more serious mental health disorder, such as serious depressive episodes, suicidal thoughts or plans, or symptoms of Bipolar Disorder (mania and debilitating depression).
A visit to a physician is highly recommended, not only to consider undiagnosed mood disorders, but to rule out potential underlying physical ailments which share common symptoms with SAD. Chronic Fatigue Syndrome (CFS) shares numerous common features with SAD, including lethargy, impaired cognition and memory, depressed mood and sleep disturbance. Likewise, anemia also shares symptoms of fatigue, lack of concentration and general uneasiness. Behavioral and emotional manifestations of hypoglycemia also include irritability, cognitive disturbances, confusion and lethargy. Symptoms of hypothyroidism also include depressed mood, fatigue, weight gain and memory impairments, similar to SAD. This list is by no means exhaustive and treatments for these illnesses vary with the prognosis largely dependent on seeking the attention of a medical professional to ensure proper diagnosis.
TREATMENT:
Depending on how debilitating or frustrating the symptoms are, the antidote to SAD is typically a combination of interventions. The three mainstream treatments include light therapy, medication management and/or psychotherapy.
Light therapy involves sitting in front of a specially manufactured (for SAD) light box for one or more sessions per day. These sessions can be as short as 15 minutes and as long as several hours, depending on the lux illumination.
Medications, in form of anti-depressants can also be utilized; however caution must be paid to undetected Bipolar disorder so that a manic episode is not triggered by the medication. A psychiatrist will be able to discern these conditions during the evaluation and will recommend the best options for medical treatment of SAD.
Psychotherapy addresses the negativistic thoughts and pessimism arising from the decrease in motivation, loss of energy and increase in withdrawal seen in SAD. In some situations, individuals may acquire adverse coping skills to deal with their sadness and depressed mood. Some may attempt self-medicating with drugs, alcohol, overeating and excessively watching TV or playing video games. These activities, although initially helpful in distracting from the unpleasant emotional state, soon morph into unhealthy and sometimes addictive behaviors which lead to further isolation, depression and hopelessness. Through therapy, deterrents are discovered and healthy behaviors promoting a proactive engagement in life are explored. Insight in gained and life becomes increasingly meaningful and hopeful.
Although alternative treatments are known to be effective, they have not been approved by the FDA and so using them should be taken prudently and pursued with caution. Homeopathic remedies, including over the counter supplements such as St. John’s Wart, SAMe, Melatonin, Omega-3 fatty acids and Vitamin D have been suggested in the treatment of SAD. Please consult your physician before you make a decision about making these a part of your regimen as side effects and dosage implications exist and possible adverse reactions may occur.
Simple interventions, however, may actually be the best catalyst for beating the winter blues. Mind-body activities such as yoga, Pilates and meditation, offer relaxation and presence of mind. Outdoor activities such as hiking, walking or even building a snow man, not only increase the likelihood of exposure to the sun’s rays, but also offer a healthy diversion from stress and encourage socialization. Arts and crafts, poetry and journaling, music and dance, are all activities which offer inspiration to further challenge and express feelings while connecting with others in a unique way.
CONCLUSION:
Each year, the trees lose their leaves and wildlife gathers reserves for the chilly months ahead. Nature slows down and rests, conserving its energies and nurturing its resources in anticipation of the birth of spring. Winter is a time of hibernation, not of idle laziness, but peace, calm and reflection. On some level, Seasonal Affective Disorder (SAD) is also just that - hibernation in anticipation of the renewal of energy with the coming of spring. We are part of the natural cycle of life which includes slowing down, in spite of our busy itineraries, and finding meaning and balance in our activity as well as in our stillness. Look within and reframe your sadness into hope. Allow yourself patience; jubilation is right around the corner, with the falling of the snow. And if this feels too impossible and you wish to reach out for help, please don’t hesitate to seek out my psychotherapeutic services.
Hope is the thing with feathers -
That perches in the soul -
And sings the tune without the words -
And never stops - at all –
- Emily Dickinson, “Hope”