Seasonal Affective Disorder, or “SAD” is a depressive condition. It takes place in the high latitudes of both hemispheres during the fall and winter months.
The clinical presentation
The main symptoms experienced by people that suffer from this condition are:
- depression
- tiredness
- increased sleep
- increased appetite
- marked decrease in energy.
- These symptoms tend to start after September in the northern hemisphere and in May in the southern hemisphere.
The origin of this disorder
SAD is considered an inheritable disease. There are genes that aggregate in families that present with this condition. The trigger for this depression is the decrease in sun light in high latitudes in the winter months. The lack of sun light causes an excess in the pineal gland secretion of Melatonin. This excess occurs during the daytime instead of at night. (the normal secretion must happen exclusively at night during the dark hours of the day).
Where this problem is seen more
This problem affects people living in high latitudes. It is seen more frequently in geographical areas in which, not only days are shorter, but there are overcast skies for long periods of time during the fall/winter season. This is the case in the pacific northwest and the northeastern United States, western and Eastern Canada, and in Alaska. This condition is also seen in Russia, the Scandinavian countries, the UK and northern Europe in general.
In the southern hemisphere, it is found in southern Argentina, Chile, Tasmania, and Antarctica. People predisposed to this condition may have milder symptoms if they live closer to the tropics where the decrease in sun light in winter is not so dramatic.
Areas that are drier and colder, like the continental states in the US, have less people suffering from SAD. The prevalence there is not to the degree of the above-mentioned geographical locations because they are sunnier. Also, because of the effect of the snow that reflects light, chances of suffering from SAD are lower in those areas.
Why we experience SAD
SAD is considered to be an exacerbation of the mechanism of hibernation humans. This mechanism is shared with animals such as the bears. Evolutionarily, the fall and winter are times to conserve energy. This conservation is carried out by moving less, eating more, and sleeping longer.
In the case of bears, hibernation takes the form of gaining weight during the spring and fall. This state is accompanied by sleeping long hours in the fall and winter. During this time, bears survive off the fat reserves their bodies accumulated in the previous seasons. Humans have these inherited mechanisms to a lesser degree than bears.
A small subset of humans, however, has kept this mechanism alive in their bodies. So, for genetic reasons, the hibernation state gets triggered in them by the season This state results in decreased energy, increased sleep and appetite, which in turn lead to weight gain and low self-esteem problems.
The differential diagnosis
The form of depression seen in SAD is what in psychiatry is known as an “Atypical Depression.” This depression is called “Atypical” because in “typical” depression people experience insomnia, decreased appetite, and weight loss, which are the opposite seen in SAD.
This depression is often mistakenly diagnosed as “Bipolar Disorder.” In Bipolar disorder, depressive episodes often have the same characteristics as depression in SAD. The difference is that in Bipolar Disorder depressions are more intense. Typically, they do not coincide with the season–and they run in families with Bipolar Disorder and not with SAD. People with Bipolar also experience manic episodes which people with SAD do not.
In bipolar disorders, depressive episodes can be so extreme that they lead to suicidal ideation and psychotic symptoms. Bipolar depressions may present with hallucinations or delusions. These serious mental health symptoms never happen in pure SAD.
Keep in mind that people who suffer from Bipolar Disorder may have an exacerbation of depressive symptoms in the fall and winter months. And Bipolars have a tendency to experience manic episodes in the spring and summer.
Even if you do not suffer from SAD, everybody who suffers from depression experiences lower energy and more depression when environmental light decreases. For this reason, Light therapy is a good measure to institute in every person suffering from depression.
What to do about SAD
1-If you experience depressive symptoms every year around the fall and/or winter months, it is possible that you suffer from Seasonal Affective Disorder.
2-Because this condition runs in families, check with other members of your family to see if they have the same problem. This piece of information may guide you and your prescriber in the direction of establishing the correct diagnosis.
3-The treatment of SAD is light therapy not medication. This fact is essential to take into account. I see hundreds of people mistakenly medicated for depression or “bipolar disorder” with undiagnosed SAD. Medication may help SAD it but not correct it.
4-No matter what type of depression you suffer from, light therapy should be a part of your treatment. However, in Bipolar depression, light treatment must be used judiciously. It can trigger a manic episode if used in excess or at the wrong time of the day (in the late evening instead of in the morning).
5-It is a common misconception that Vitamin D replaces light therapy. This is not the case. Vitamin D3 is synthesized by our bodies when we get tanned in the summer time. If you get exposure to enough light through your eyes but you do not tan, then you are not making enough Vitamin D. Light therapy does not increase your Vitamin D Levels.
6-Lighttherapy works by increasing the amount of light that gets into your brain though your eyes. Light decreases thereby the production of excess melatonin during the day time which seems to be the cause of Seasonal Affective Disorder.
How to prevent and treat SAD
1-You need to check yourself for these symptoms and arrive at the correct diagnosis with the help of a psychiatrist.
2-Make sure you do not suffer from Bipolar Disorder and that there are no other environmental or psychological triggers such as the “holiday blues” or anniversary reactions.
3-You should take 1000 to 2000 international units of Vitamin D 3 in capsules every morning. Take them with your breakfast after having your Vitamin D3 levels measured by your doctor. If levels are low, then you need Vitamin D 3 supplementation. Your doctor must recheck your vitamin D levels during and after replacement therapy.
Note that it is good practice to have these levels higher rather than lower to avoid depression. But, you should Not overdue your Vitamin D replacement as this vitamin accumulates in your body. Therefore, an excess of this vitamin can be toxic for you. So, AVOID OVERDOING YOUR VITAMIN D REPLACEMENT and do this replacement under medical supervision.
2-Get a lightbox for light therapy.
- Remember, putting on extra or more regular lights in your home does not resolve the problem.
- Get a white light and not an electronic blue light. They are kinder on the eyes.
- Tubes and more modern LED screens are better tolerated than the older multilocular LED light boxes.
- There are many products of different prices and sizes you can order online. Prices range from 50 dollars to over a few hundred dollars. Spending 100 dollars would suffice to get a great quality product.
- I prefer using a portable midsize light box to carry it around the house or take it to work.
- The lightbox must have a minimum power of 10 thousand luxes. The minimum time of exposure is 30 minutes in the morning. You can use it for longer periods of time as needed.
3-The light source you use must be about 2 feet away from you. You must not look directly into the light. The light must hit your eyes at a 45-degree angle while you are doing something else such as reading, having your morning cup of java, or checking your computer emails.
Side effects of light therapy are rare. Some people with eye vision problems or cataracts may not tolerate strong light or get a mild headache. Most people do not experience side effects. And they feel a hundred percent better once they introduce light therapy into their daily routines.
4-If you do not have time to do this exposure, get two light boxes and turn them on in your bathroom. Get exposed to light while you are doing your toiletry to start your day on the right foot. Place them at both angles of your large mirror in front of you in your bathroom. You can also attain the same result by having one lightbox and a stand mirror on the other side of the box to amplify its effect.
5-Light can be used for longer periods of time but always in the morning and early afternoon. Never use light therapy after 5 PM. This is particularly important to keep in mind if you suffer from bipolar depression to avoid a manic switch.
The best way of treating and preventing winter depression
Best Preventive Measures
Add aerobic physical activity to strong light. This can be achieved by taking brisk walks in the middle of the day whenever there is enough light out there and weather permits. Forty-five minutes to an hour is the ideal amount. You can achieve this too by hitting the gym and walking on a treadmill; or doing it at home by using your own treadmill while watching TV with your SAD light on.
Finally, for some people with severe cases of SAD, the “cure” for it is to move to southern states or live near the tropics or the equator. I hope this post help you prevent or deal with this vexing condition. More on depression, its diagnosis and treatments on coming posts.
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And have a peaceful holiday season
Dr T
The light therapy does have a positive effect on SAD depression. I appreciated the information.