Pittsburgh has had a lot of dreary days lately, so it’s not unusual to feel a little depressed and out of sorts from time to time. But as the lack of sunlight increases over the winter months—with some people going to work in the dark and returning home in the dark—some people begin to feel even more depressed and for longer periods of time.
Known as SAD, or seasonal affective disorder, this form of depression usually starts in the fall and remits in the spring or summer.
“While summer depression does exist, it is much less frequent,” explained Alicia Kaplan, MD, a psychiatrist at Allegheny Health Network and medical director for the Center for Adult Anxiety and OCD.
While some people may have manic episodes, SAD is more commonly seen in major depressive episodes with symptoms that can include lethargy, low energy, cravings for carbohydrates, weight gain, sleeping too much, eating too much, a lack of drive, and sadness, in addition to other typical symptoms of depression.
“It is actually pretty common; in clinical settings, approximately 5-10 percent of primary care patients may have SAD,” said Dr. Kaplan. “In my practice, I see some patients who have purely seasonal depression, and others who have depression already but it gets worse in the wintertime.”
According to a podcast featuring Kathryn Roecklein, Ph.D., associate professor of psychology and the primary investigator of the Seasonality Research program at the University of Pittsburgh, one of the environmental variables that is most closely tied to the onset of SAD is day length. “The time from sunrise to sunset, called the photo period or day length, is the main trigger for the onset of depression in fall and winter,” she said.
When the seasons change, people may experience a shift in their internal biological clock, (circadian rhythm), and lack of daylight can also affect the body’s production of melatonin, the hormone that helps control the body’s internal clock and sleep cycle. Other factors, such as not being able to take part in outdoor activities during the winter months, may also contribute to SAD.
Treatments for Seasonal Affective Disorder
Depending on how intensely a person is suffering from SAD, behavioral changes may help to alleviate symptoms.
“I talk to patients about making sure they sit by a bright window to get as much light as they can, and getting outside, and exercising,” said Dr. Kaplan. “I also emphasize having a regular sleeping pattern, minimizing alcohol, and sticking to a healthy diet. It also helps to engage with others.”
If the condition is more serious, other treatment strategies may include adjusting medications to regulate neurotransmitters, which are involved in what causes SAD. Bright light therapy is also a popular treatment, but should be cleared with a doctor first, especially in those patients with a history of retinal disease or who take photosynthetic medications.
“Patients need to be educated about bright light therapy, because not all light boxes are the same,” said Dr. Kaplan. “They have to be a certain intensity, at least 10,000 lux for SAD treatment.”
Psychotherapy has also been shown to have positive results in lessening depression overall.
“While the stress of the holidays, as well as dealing with trauma or loss at this time of year are not part of SAD, certain psychosocial stressors at this time of year can add to and aggravate depression,” said Dr. Kaplan. “Psychotherapy helps with problem solving, and using cognitive skills to approach situations differently to help patients cope and adapt.”
While some people think that they can just wait it out since winter only lasts so long, it’s important to realize that not treating SAD can lead to other issues as well.
“SAD is considered a subtype of clinical depression, and there can be secondary effects from untreated depression medically,” said Dr. Kaplan. “People who are not taking care of themselves and are eating incorrectly or leading a sedentary lifestyle may develop problems with cholesterol and blood sugar. If they are neglecting their health and not keeping up with doctors’ appointments, it could affect them physically.”
She notes that if people are not engaging with others, missing work and social interactions, or not taking care of themselves, it is important that they see a mental health professional, though this becomes even more difficult as the motivation to get help often goes away with depression.
“There is help out there, and depression is not something to be taken lightly,” said Dr. Kaplan. “It’s nothing to be ashamed of. It affects a lot of people, and you are not alone.”