Seasonal changes are known to affect those suffering from a number of psychiatric complaints. Seasonal affective disorder (S.A.D.) is the most common diagnosis for those suffering from seasonal changes. S.A.D. affects about 6% of the U.S. population. A milder form of S.A.D., known as the Winter Blues or Subsyndromal S.A.D., affects approximately 14 % of the U.S. population. Add to this the number of people with mood disorders (depression and bipolar disorder) who exhibit ‘seasonality’, and the numbers of those affected by the seasons grows.
There are a couple of seasonal patterns possible in S.A.D.: the more common pattern is the winter seasonal pattern, where one typically feels worse in December, January and February. There are however those who suffer most in July and August and who are considered to have a summer seasonal pattern. (I will be writing largely about those suffering from winter seasonal pattern herein, but the same principles largely apply to the summer pattern too.)
Seasonal affective disorder is characterized by a number of changes in:
Mood: Increased sadness, irritability, self-blame and an increased desire to be alone are typically reported.
Cognition: There are often troubles thinking clearly and slower thought processes with decreased concentration, productivity and creativity. There are often increased work absences. (These signs/symptoms have been shown to improve with light therapy.)
Eating: There is a tendency towards increased food consumption and to preferentially eat more carbohydrates. (It has been shown that those with S.A.D. secrete excess insulin in response to eating carbohydrates. This tendency subsides with light treatment and in summer months.)
Sleeping: There is difficulty waking in the morning and one sleeps more but is still unrefreshed on waking. Decreased slow wave sleep and increased sleep disruptions have been documented.
Sex drive: Decreased
Those adversely affected by the seasons also generally experience a worsening of most physical complaints in the winter. Women will often notice a worsening of premenstrual syndrome (PMS) in the winter.
Light -Those with atypical symptoms (increased eating, increased sleeping and increased weight with depressive symptoms) respond best to light treatment. It is best to start light treatment as soon as first depressive/S.A.D. symptoms appear (for some this may be late summer or early fall). Light treatment early on may prevent worsening of symptoms later in the season. Those with bipolar disorder should not use light therapy without clinical supervision as it can induce hypomania/mania if not used correctly.
Sleep– Sleep restriction can be helpful for some. The use of dawn simulators and/or a.m. light exposure can help regulate the sleep wake-cycle
Diet– Those with S.A.D. often benefit from a lower carbohydrate diet and may be well-served to more closely monitor their diet and weight during the winter months.
Exercise– regular aerobic exercise can enhance mood…and often gives one something productive to do in front of a light box!
Naturopathic Treatment– A variety of supplements, herbs and homeopathic remedies can be of benefit in addressing S.A.D. symptoms and comorbid complaints.
Psychotherapy– Cognitive Behavioral Therapy (CBT) is often advised for those suffering from S.A.D., though I think many psychotherapeutic approaches can be of benefit.
Pharmacotherapy– Antidepressants may be prescribed and often work synergistically with light therapy. See my blog posting on the caveats of antidepressants in bipolar disorder (many S.A.D. sufferers have bipolar disorder).
Mood logs– Mood logs/diaries can be invaluable for establishing one’s individual pattern of S.A.D., monitoring symptoms and preparing for future months and years ahead.
Other– Additional treatments include winter vacations to a sunny location, dawn simulators and negative ion generators. Check my blog periodically over the coming months for postings on S.A.D. and related topics for more…
- Center for Environmental Therapeutics- self-assessment questionnaires: https://www.cet.org/self-assessment/
- Winter Blues by Norman E. Rosenthal, M.D.
- www.psycheducation.org (A site created and maintained by James Phelps, M.D.)
Rosenthal, N.E. (2006). Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder. (Revised ed.). New York, NY: The Guilford Press.