Understanding Seasonal Depression

Ever wondered why a certain part of the year makes you feel a little blue? We all have either felt quite low or at least heard about people feeling so during certain seasons. Even though it might seem quite innocuous to pass this off as insignificant, there can be an underlying concern.
The kind of depression that can make a selective appearance during certain seasons, could actually be a very diagnosable condition called seasonal affective disorder (whose acronym very coincidentally reads as ‘SAD’) or sometimes simply ‘seasonal depression’. 

We will be using this acronym from here on out, for the sake of convenience, & should NOT be confused with Social Anxiety Disorder, with the same acronym.

Seasonal Affective Disorder, is a type of recurring mood disorder that occurs at the same time/season, every year, with symptoms lasting up to maybe 40% of the year or more. 

The most common form of seasonal depression starts from either early fall or the winter months extending into spring or early summer, called ‘winter-pattern seasonal affective disorder’. There is also a less common variant of this disorder which makes its appearance in the summer months, lasting up to the onset of winter called ‘summer-pattern seasonal affective disorder’. It is known to affect only about 10% of all people who have reported some form of seasonal depression.

Someone who is struggling with SAD may experience the symptoms typically associated with depression, like:

• Persistent low mood
• Feelings of hopelessness/listlessness
• Difficulty concentrating
• Anxiety
• Fatigue & digestion issues
• Disturbed sleep patterns
• Sudden appetite &/or weight fluctuations
• Suicidal ideation (in some cases)

In addition to the main symptoms, depending on the type, individuals might also develop certain other “season-specific” symptoms. For example, Individuals experiencing winter-pattern SAD might oversleep (hypersomnia), avoid social interactions, & also develop a sudden affinity to overeating, especially carbohydrate-rich foods, potentially leading to weight gain. Whereas those experiencing summer-pattern SAD might struggle with insomnia, appetite loss leading to loss of weight, restlessness, irritability, etc. 

SAD can often be confused with unpleasant moods associated with the stresses caused by the holiday season. Some people can also experience a milder form of depression, maybe due to their changing work & social schedules during the holidays, & the stresses that come with accommodating these changes. However, SAD is more about changes in environmental factors that are characteristic of the season & its association to depressive episodes. 

In order to get diagnosed, the symptoms have to be consistently reappearing around the same time, for a minimum of two (consecutive) years; and the depressive symptoms are more severe during a particular season than any other part of the year. There is of course nuance in clinical judgment as people may present differently so it is best to get diagnosed by a professional.

It should be noted that a majority of the research is primarily focused on ‘winter-pattern’ SAD, as more people experience it in the winter as opposed to summer. Research suggests it can affect up to 11 million people in the US every year, while about 25 million more are affected by the milder winter blues. In India, it has been reported that approximately 10 million people might experience SAD.

What can cause SAD?

Even though the exact cause is yet to be ascertained, there might be several factors that can potentially contribute to its development.

Seasonal changes might also affect the balance of the sleep hormone (melatonin) resulting in disturbed sleep patterns. Secretion of melatonin is highest when there is darkness, so, during summer, higher exposure to light, heat & humidity can have a detrimental effect on melatonin production, interfering with sleep cycles, which can lend itself to depressive symptoms. Alternatively, those struggling with winter-pattern SAD can also have disturbed sleep cycles, due to overproduction of melatonin (resulting in hypersomnia) when natural light is scarce. 

During Winter, the relative reduction or lack of sunlight can cause a drop in the serotonin levels, which can adversely affect mood since research suggests that sunlight can help regulate our serotonin levels. A Vitamin D deficiency due to reduced exposure to sunlight may also play a role as one of the probable causes as it has a favourable impact on improving serotonin levels, & thus impacting mood regulation. 

Furthermore, some studies also suggest that serotonin might also help regulate our consumption of carbohydrates which might explain certain cravings & weight gain symptoms. 

Disruption to the Circadian rhythm (body’s internal clock) is also theorised to be a reason for SAD, as light is a key indicator that helps our circadian system to distinguish between night and day. People with preexisting mental health conditions or having a family history of SAD have also been reported to be more prone to experiencing SAD. 

It is important to note that SAD could simply be caused by any of the above or could be a culmination of all these, to various degrees. It is important to discuss with your healthcare providers, in case of questions or clarifications. 

How can I take care of myself? 

It might be difficult to prevent the onset as it is dependent on multiple factors, however, if you are experiencing SAD or expecting an episode, here are some self-care strategies: 

• Proper exposure to natural light: A few minutes every day in the early morning light can do wonders for Vitamin D levels in the body.

• Eating a balanced diet & staying hydrated: Consuming all the necessary nutrients like carbohydrates, proteins, vitamins, etc., in the quantities required by our body is essential. Avoid oily/junk food & drink lots of water. Consult a medical professional for creating balanced options, if you require.

• Build & maintain a routine: Having a routine for activities as well as food & sleep can make it easier on the body, and can play a role in general wellness. 
• Consider regularly doing some form of workout: If possible, add a high-energy activity to your days as it can help with the proper functioning of necessary neurotransmitters like serotonin, dopamine and melatonin. 

• At-home light therapy: If available, get a 10000 lux lamp that can help you get your requirement of light by exposure for 20-30 mins and start using it from early fall (long before the onset of symptoms of winter pattern SAD). Consult a professional prior to ascertaining what might work best for you.

• Social Engagement: Regular contact with our loved ones can be of great help, as well as consciously trying not to withdraw during this period can have a significant impact.

• Taking hot/cold showers depending on the weather conditions can greatly contribute to regulating mood & also curbing any irritation arising from fluctuating temperatures and atmospheric conditions.

• Develop a personalised treatment plan with a mental health professional.

How might professionals treat SAD?

There are a variety of available treatment options, however, the majority of them cater to winter-pattern SAD due to skewed research. Furthermore, a mental health professional may use a variety of other modalities based on their skills and expertise. Please discuss any concerns you may have regarding your treatment with them.

LIGHT THERAPY

Since the 1980’s Light therapy has sort of been the go-to answer to winter-pattern SAD symptoms. Due to the shortage of natural sunlight during the winter months, the individual might be made to sit in front of a light box (10000 lux bright full spectrum light) for around 10-15 mins per day for starters, and eventually 30-45 mins every day. It would be commonly advised to administer this treatment, as the first activity in the morning, from the beginning of fall, sometimes continuing well into the onset of spring. The light box is a very safe treatment option, as it is designed to filter out harmful UV light, and it can be very efficient, providing light that is up to 20 times brighter than natural indoor light.
Another alternate method is the use of a dawn simulator, which is essentially an alarm, with light instead of (or in addition to) sound. It is designed to emulate a natural sunrise, where light is slowly emitted, in sync with a timer. Light therapy has been proven to be a great option for SAD treatment, as it provides an antidepressant effect, by aiding in the production of adequate serotonin.

Vitamin D supplements

This option is directed more towards winter-pattern SAD when the individual is more likely to have a vitamin D deficiency, which could be a contributing factor to their symptoms. Professionals may also advise adding naturally vitamin D-rich foods, like oily fatty fish, red meat, egg yolks, plant-based milks, etc., to the diet. However, general vitamin D deficiency is not season-specific, hence, it is best to get tested yearly (minimum) & ensure you have enough nutrient-rich foods in your diet. 

Psychotherapy

The role of therapy could be to equip individuals with the necessary resources to manage unhealthy patterns of feelings, thoughts and behaviours. One such form of psychotherapy called CBT (cognitive behavioural therapy) is among the preferred treatment modalities, where individuals might be guided to identify  & navigate dysfunctional thoughts along with building healthy routines which can help manage the symptoms of depression. Therapists may also target the unpleasant feelings associated with the season, like the heat/brightness of summer or the darkness/coldness of winter. As per studies, CBT has been comparable to light therapy in its efficacy, however light therapy can be a more swift solution. It is also important to note that CBT is only one mode of psychotherapy, trained therapists may also use other modalities like MBCT, psychodynamic therapies, etc to help individuals navigate their experiences with SAD.

Antidepressants

Individuals may be prescribed antidepressants, depending on the severity & specifics of symptoms, in order to stabilise mood & stress responses. It may take psychiatric medicines at least 4 weeks to produce a noticeable difference.

For a condition that is so prevalent, there still seems to be a lack of awareness as well as seriousness. It is important that individuals (with the help of a professional) document symptoms & check if there is an identifiable pattern, with respect to its onset, or which parts of the year lead to the exacerbation of symptoms.
Once diagnosed with SAD, practicing self-care is essential and so is following the advice of your mental health professional, to help navigate this condition with the necessary tools which can help one function most effectively.