☀️ How the Seasons Influence Our Mood: Understanding Seasonal Affective Disorder (SAD) ❄️

Seasonal affective Disorder (SAD) is a type of mood disorder. It causes symptoms mostly during a specific period of the year, typically during the fall and winter months when the days are shorter and darker. Though this ailment normally resolves after a few months, it can have a significant impact on how a person feels and operates.

People's mood swings vary with the seasons, which is not unusual. Perhaps you've noticed that a dreary and rainy day makes you depressed and lethargic, whereas a sunny day gets you joyful and energized.

Summer's longer and sunnier days have been linked to better moods, whereas as the days get shorter and darker in late fall, SAD symptoms tend to worsen.

Symptoms:

SAD symptoms develop on a continuous basis, with symptoms returning each winter. Symptoms may include:

• Depression

• Fatigue

• Social withdrawal

• Increased sleep

• Increased appetite and carbohydrate cravings

• Weight gain

• Irritability

• Interpersonal difficulties (especially rejection sensitivity)

• A heavy, leaden feeling in the arms or legs

Causes: 

It is believed that seasonal affective disorder is due to an altercation in the body's normal circadian rhythm. This is influenced by the sunlight entering through the eyes.

In darkness, melatonin is a chemical secreted by the pineal gland which can very well explain the drowsy feeling one gets each day during the onset of dark. Light entering through the eyes at dawn closes down melatonin biosynthesis altogether.

Low sunlight has been connected with neurotransmitters melatonin and serotonin reduced, carbohydrate craving, weight gain, and sleep disturbance.

In winter's shorter days, individuals may rise before dawn and not leave their offices until after sunset; thus normal rhythms may be disrupted, producing the symptoms of SAD.

There is also evidence associating SAD with a shortage of neurotransmitter serotonin. Serotonin is the happy chemical whose levels are enhanced by a category of antidepressants known as SSRIs.

Diagnosis:

There is no laboratory test available for SAD, only the history of symptoms presented by a person using the criteria laid out in the DSM- 5 to diagnose.

The DSM-5 does not regard SAD as a separate disorder but as a "specifier" of a major depressive episode diagnosis. For one to be diagnosed with SAD, they must first of all meet the criteria for a major depressive episode.

The following symptoms need to appear nearly every day for a period of two weeks. Also the at least one of the person's symptoms must be either one of the first two items on this list.

• A depressed mood due to a medical condition, or related to the content of a delusion or hallucination which the person may be experiencing is not taken into consideration

• Depressed mood

• Loss of interest in activities that were once considered pleasurable

• Changes in either appetite or weight, without the intent of curtailing food intake for the purpose of gaining or losing weight 

• Sleeping excessively or not enough 

• Psychomotor agitation or retardation 

• Fatigue or loss of energy 

• Feelings of worthlessness or excessive/decessive guilt 

• Problems concentrating, thinking, or making decisions 

• Thoughts of death or suicide

Any symptoms that might be more fundamentally explained by proximity to a medical condition, the use of a substance, or bereavement would not count toward a major depressive diagnosis. The psychotic disorder, in other words schizoaffective disorder must be ruled out as accounting for the symptoms.

In addition to these above criteria being met, the following would also have to be satisfied in order to receive a seasonal pattern specifier :

A seasonal major depressive episode is one with a characteristic temporal relationship between the onset and cessation of the major depressive episodes and a specific time of the year.

There has been a relationship between the onset and cessation of the person's major depressive episodes for at least two consecutive years during the past two years, without any non-seasonal major depressive episodes.

There has been a pattern, predominantly of seasonal major depressive episodes over an individual's lifetime.

Treatment:

Seasonal affective therapy is generally responsive to available treatments. Three common treatments for SAD are light therapy, medication, and psychotherapy.

Light Therapy:

Light therapy with a bright, white light-emitting device is presently the most effective treatment for SAD. In fall of 1998, 13 Canadian experts issued a professional consensus guideline statement in the treatment of SAD.

Among their conclusions were :

• The initial "dose" for light therapy using a fluorescent light box is 10,000 lux for 30 minutes daily. Or, light boxes emitting 2,500 lux require two hours of exposure daily.

• To achieve optimum response to treatment, light therapy should be instituted early in the morning upon awakening.

• Response to light therapy may be seen within one week, though patients who do not respond may take up to four weeks.

• Common side effects of light therapy include headache, eyestrain, nausea, and agitation; however, these tend to be moderate, temporary, or resolve with lowered dosages of light.

In the United States, consensus would appear to exist that post-dawn bright light therapy using a broad-spectrum white light source given at 10,000 lux is first-order intervention.

Drugs should be introduced as adjuvants only if light therapy is not sufficient.

In one such study, appearing in the Archives of General Psychiatry, individuals with SAD were exposed to bright lights that were 10 to 20 times brighter than typical indoor electrical lights.6

One group received the therapy in the mornings for approximately an hour and a half. The evening bright light exposure was done for another group of participants. Another group received a placebo treatment.

Complete or nearly complete remission of depression was achieved among the patients from the morning bright light therapies.

Newer studies appearing in the Journal of Nervous and Mental Disease show that as few as one-hour light session can produce fast symptom improvement of depression in SAD-suffering individuals.7 And therapy done in the morning in particular is able to reset any disturbed sleep-wake cycle responsible for the symptoms.

Medications:

On June 12, 2006, Wellbutrin XL (bupropion hydrochloride) became the first drug approved specifically for SAD in the United States.

The efficacy of Wellbutrin XL in the prevention of SAD episodes was established in three double-blind, placebo-controlled trials in adult patients with a history of major depressive disorder in fall and winter.

Treatment started in the September to November period, well before the onset of symptoms. Treatment was discontinued the first week of spring.

In these studies, the percentage of patients who were depression-free at the end of treatment was significantly higher in Wellbutrin XL-treated patients than in placebo-treated patients.

The overall rate of patients depression-free at the end of treatment across the three studies was 84% for those on Wellbutrin XL and 72% for those on placebo.

Wellbutrin XL is chemically unrelated to the other common antidepressant medications, a class of drugs called SSRIs. As a matter of fact, there is no convincing evidence from randomized trials to support the use of SSRIs in treating SAD.

Psychotherapy:

Cognitive-behavioral therapy may also be appropriate in SAD treatment, as well as light therapy and medication. It includes learning to recognize negative thought patterns contributing to symptoms and replacing them with more positive thoughts.