Column: Feeling low? It might be that time of year.

By: Justine Suba-Cohen, DO
Southwest Medical, part of Optum

It’s part of the human condition to sometimes feel sad, downcast or “just not ourselves.” But
for some of us, depressive moods begin and end when the seasons change. [1]

When these mood changes are more serious and affect how you feel, think and behave,
and when these feelings change with the seasons, you may be experiencing seasonal
affective disorder, or ‘SAD.’ [2]

Symptoms of SAD typically start in late fall or early winter and go away during spring and
summer. This is referred to as “winter-pattern SAD” or winter depression. There are some
people who experience depressive symptoms during spring and summer, and this is known
as “summer-pattern SAD,” or summer depression. However, summer-pattern SAD is less
common. [3]

SAD is characterized by a recurring seasonal pattern, with symptoms lasting about four or
five months out of the year. [4] These symptoms can include: [5]

• Changes in sleep or appetite
• Decreased energy
• Difficulty concentrating, remembering, or making decisions
• Feelings of:
  • frustration
  • guilt
  • helplessness
  • hopelessness
  • irritability
  • restlessness
  • worthlessness
• Loss of interest in favorite hobbies and activities
• An ongoing sad, anxious, or “empty” mood most of the day, nearly every day, for at
  least two weeks
• Physical aches or pains, including headaches, cramps, or digestive problems that
  don’t have a clear physical cause and don’t go away with treatment
• Thoughts of death or suicide or suicide attempts
• Unplanned weight change

Who develops SAD?

It’s estimated that millions of Americans experience SAD, though many of them may not
know they have it. In most cases, SAD begins in early adulthood. [6]

SAD occurs much more often in women than men. It sometimes runs in families and may
be more common in people who have relatives with other mental illnesses, such as
depression or schizophrenia. [7]

Diagnosing SAD

To be diagnosed with SAD, a person must meet the following: [8]

• They have the symptoms of depression, or the more specific symptoms of winter- or
  summer-pattern SAD.
• Their depressive episodes occur during specific seasons (winter or summer) for atmo
  least two consecutive years.
• These seasonal depressive episodes are more frequent than depressive episodes
  experienced at other times of the year.

If you or someone you know is showing symptoms of SAD, talk to a health care provider or
a mental health specialist.

Possible causes of SAD

While researchers are still determining what causes SAD, studies indicate that people with
SAD have reduced levels of serotonin, the brain chemical which helps regulate mood. [9]

Other studies suggest that both summer and winter forms of SAD relate to altered levels of
melatonin – a hormone that helps to maintain normal sleep−wake cycles. [10]

In people with SAD, changes in serotonin and melatonin disrupt normal rhythms and they
can no longer adjust to seasonal changes in day length, leading to sleep, mood and
behavior changes. [11]

SAD treatments

The treatments available for people with SAD can be used alone or in combination: [12]

• Light therapy
• Psychotherapy
• Antidepressant medication
• Vitamin D

Sources:

[1] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[2] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[3] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[4] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[5] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[6] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[7] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[8] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[9] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[10] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[11] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder
[12] https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder