From healio.com
Key takeaways:
- Seasonal affective disorder impacts those from many backgrounds, locations and climates.
- SAD and depression can have intertwined symptoms.
- Care partners are vital to the process of dealing with SAD.
On the first Sunday of November, when the majority of the United States set their clocks an hour earlier, the resulting earlier sunrises also meant earlier sunsets.
With the onset of the coldest and darkest months of the year throughout most of the country coinciding with this time adjustment, individuals often struggle to remain awake, aware, active and mentally on an even keel.
According to the American Psychiatric Association, approximately 5% of U.S. citizens experience this phenomenon, known as seasonal affective disorder (SAD), which can persist for roughly 40% of the calendar year.
Experts from across the health care spectrum, based at different locales, explain why it is important for those who may be susceptible as well as friends and family members to be mindful of never dismissing the condition merely as the winter blues.
SAD can strike anytime, anywhere
SAD is a unique type of mood disorder often positioned under the umbrella of major depressive disorder. Its onset is most often seen in the fall and winter, particularly in the Northern Hemisphere, when the days become shorter and there is less access to sunlight.
“The difference between a diagnosis of major depressive disorder and SAD is the remission of depressive symptoms as the seasons change,” Gina Harrison, DNP, CRNP, PMHNP-BC, of nursing at Wilkes University in Pennsylvania and a psychiatric‐mental health nurse practitioner, told Healio.
“People who are diagnosed with SAD often improve in the spring and summer when the daylight becomes more abundant,” she said.
Occurrence of SAD varies based on geographic location, as there typically are fewer people in Florida diagnosed with SAD compared with states like Maine or Alaska. Nonetheless, the rate of SAD can vary between 1% to 9%, based on location.
Individuals who suspect they are experiencing SAD may notice they require increased sleep, increased appetite along with weight gain and an increase in a desire to consume carbohydrate-based “comfort” foods.
SAD and depressive disorders have some intertwining symptoms, Harrison added, including depressed mood, low energy and motivation, along with decrease of interest in and loss of the ability to feel joy and pleasure in normal daily activities.
That doesn’t mean the condition is limited to the darker and colder times of the year.
Risk factors for SAD include seasonal changes and familial history, with more women than men experiencing SAD, whose onset typically occurs for individuals aged 18 to 30 years.
“Less commonly, people may experience depressive symptoms that occur in the spring and summer months,” Harrison said. “This is known as summer-pattern SAD.”
According to Harrison, while it is less common, symptoms and presentation of summer-pattern SAD are similar to winter-pattern SAD, with an onset in the warmer and lighter months and remission of symptoms as light and warmth grow scarce.
‘Fish out of water’ feeling in SAD
Clinically speaking, according to Helen Marlo, PhD, dean of Notre Dame de Namur University’s School of Psychology, individuals who more vulnerable to SAD are distinguished by physiological and psychological sensitivity to decreased light exposure, changes in circadian rhythm and heightened reactivity to seasonal lifestyle changes.
“The seasonal changes can lead to functional changes, especially increased withdrawal, which frequently causes problems in personal and professional relationships with partners, families, friends and work associates,” said Marlo, a licensed clinical psychologist and psychoanalyst for the past three decades.
The most influential factor, in Marlo’s opinion, is a “mismatch” between an individual and their environment, as someone living in a climate that taxes their biology and psychology is like a “fish out of water.” The environmental factors generally intersect with psychological issues, which hold psychological meaning, and influence individuals in ways that impact their daily functioning.
“This mismatch doesn’t work well for their physical and mental health,” she said.
Marlo cited examples from her own clinical experience, such as patients who lived in sunny climates but who hated the sun and heat. They felt more irritable, short-tempered, depressed and fatigued in warmer climates. In another case, a patient that a change from a warmer, sunnier environmental to one colder with more rain to a work culture more conducive to their well-being.
“I worked with a college student who self-identified and met the diagnostic criteria for SAD,” Marlo explained. “While light therapy was beneficial for him, he also had significant trauma and unresolved grief from his father’s winter suicide.”
In this case, she added, trauma-informed depth psychotherapy significantly reduced his symptoms.
Although Marlo herself has never experienced SAD, she made a conscious decision to live her adult life in a section of California with a moderate climate after spending her youth in the Midwest.
“I hated both the cold Midwestern winters and the hot, humid summers,” she said. “While I am not particularly sensitive to changes in daylight, time, weather or circadian rhythm, that is not true for many people.”
As far as advice for fellow clinicians, she said it is helpful to assist patients in their understanding of what they associate with environmental factors that lead to SAD and how they impact their lifestyle. For example, darkness may be a trigger for someone who associates it with being left alone as a child.
These factors are real and human and while they are not influential for many people, they impact a significant number of individuals, Marlo said. SAD underscores the diversity within the human experience when it comes to these factors, which are not necessarily weaknesses in strength, capability, or intelligence.
Non-clinical experiences affirmed the reality and humanness of these factors for people and the diversity within the human experience, which are not necessarily related to strength or intelligence, Marlo said.
A downside to the physiological changes that accompany SAD is the possibility of violence or suicidality, both of which, according to Marlo, are more likely due to co-occurring mental health conditions. Weather, time changes and availability of light can easily tip the scales.
Exposure to less light during winter is associated with reduced serotonin levels. For an individual who is sensitive to these influences, if that time of year is associated with a traumatic event the death of a spouse, less frequent socialization and reduced participation in a meaningful hobby, their SAD may be exacerbated by both biological and psychological factors, leading to violence or suicidality.
“Prevention of violence and suicidality is key,” Marlo said. “This means treating known factors of light, environment and time as worthy of clinical attention and.”
This intentionality includes paying attention to all contributing factors, including environmental influences and the ripple effects these factors can have on functioning. “Failing to recognize their real influence can also lead individuals down a rabbit hole driven by their worst fears,” she noted.
‘Reframing thoughts’ in SAD
One might expect a country as vast as the U.S., with varied climates and levels of sunshine, to have developed a body of knowledge tracking different cultural or geographic methods of dealing with SAD.
Not necessarily so, according to Shawn Guiling, PhD, assistant professor of psychology and counselling at Southeast Missouri State University.
“While there are not many studies dealing directly with cultural or geographic methods of dealing with SAD, light therapy remains a very popular response,” he told Healio.
Light therapy in multiple forms has a history as an effective treatment for SAD, whether through use of a Litebook, a fluorescent light box, light visors or other wearable devices. Other interventions Guiling mentioned included a combination of prescribed medication and nutritional approaches, with a therapeutic focus on binge eating, emotional eating and tracing various types of foods consumed.
The burden of SAD extends far beyond the individual with Beck’s cognitive triad of negative views of self, future and the world are simple ways to frame our daily experiences, Guiling suggested.
“Our partners, children or other family members can participate by aiding us with monitoring our thoughts and gently encouraging us to replace or reframe those thoughts, or directing us to our mental health professionals to work directly on addressing our thought life,” he said.
These care partners are key communicators who can remind us of self-care: diet exercise, and time spent in proximity to others.
Instead of telling ourselves that nothing good will come of our participation in our daily life events, individuals can reframe these thoughts as reminders that if they can accomplish one thing, they can accomplish another.
“At the least, we can remind ourselves that our participation in our daily life events has meaning and we have worth,” he said.
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