What is SAD and what can you do about it?

By: Michela Reinink

As the winter begins to ease up and we get more hours of daylight, some may start to notice that their mood has improved significantly, or that the struggles they faced with mental illness for the past several months begin to relent. This may be an indicator of seasonal affective disorder. 

Seasonal affective disorder (SAD) is a real mood disorder that affects individuals during the same season each year, which is typically winter. The symptoms of SAD are the same as those of depression, including changes in appetite; trouble sleeping; a sad, despairing mood that persists throughout the day; and lasts more than two weeks. These symptoms impair a person’s day-to-day life by promoting the loss of interest in hobbies; increasing distractibility; and contributing to thoughts of suicide (CAMH, 2020). Research shows that SAD is triggered by changes in the amount of light that a person is exposed to. These changes in light may disturb a person’s biological clock that controls the sleep cycle and may disturb the proper functioning of neurotransmitters, such as serotonin and dopamine (CAMH, 2020).

There are certain factors that increase chances of developing SAD that are largely out of a person’s control. For example, women are more likely to be diagnosed with SAD than men (CAMH, 2020). Additionally, individuals with a family history of depression and adolescents are more likely to develop the mood disorder (Booker and Hellekson, 1992). Increased distance from the equator can also increase chances of being affected by SAD, as those closer to the equator experience less fluctuations in the amount of daylight they experience from season to season. In the United States, SAD affects only 1.4% of Floridians, but 9.9% of Alaskans (Booker and Hellekson, 1992). 

However, this does not mean that those who develop SAD are destined to a life of perpetual winter depression. Some evidence suggests the use of light therapy in reducing SAD symptoms (Terman et al., 1989). Light therapy involves exposing the patient to a lightbox, which emits more lumens than normal indoor lights, mimicking natural light more closely. One study investigated the anti-depressant effects on people with SAD by comparing the photo-effects to a negative control group. It was found that the exposure to bright light positively affected the mood of the group affected by SAD, but not those in the control group (Kasper et al., 1989). Additionally, the beneficial effects on patients depended on the length of exposure time, with a longer period being more effective. Although it is not practical for most people to dedicate a substantial amount of time to light therapy, doctors generally recommend 30-60 minutes daily. 

​There are several other methods of treatment for SAD. Medication may be prescribed during the winter months as anticipatory treatment. Selective serotonin reuptake inhibitors (SSRIs) have been found to be effective in treating SAD (Modell et al., 2005). Physical exercise is recommended to SAD patients, as well as a balanced diet. Furthermore, having a strong support network is important, and speaking to friends, family, colleagues, or a therapist is highly encouraged. Regardless of the seasonality of this mood disorder, SAD is a serious issue, and people who are affected do not have to wait until spring to get better, but are encouraged to reach out and ask for help to find solutions. 

References

Booker, J. M. and C. J. Hellekson. (1992). Prevalence of seasonal affective disorder in Alaska. The American Journal of Psychiatry 149(9): 1176-1182. 

Howland RH (January 2009). "Somatic therapies for seasonal affective disorder". Journal of Psychosocial Nursing and Mental Health Services 47 (1): 17–20. 
Kasper, S., Rogers, S. L., Yancey, A., Schulz, P. M., Skwerer, R. G., & Rosenthal, N. E. (1989). Phototherapy in individuals with and without subsyndromal seasonal affective disorder. Archives of General Psychiatry, 46(9), 837–844. 

Modell, J. G., N. E. Rosenthal, A. E. Harriett, A. Krishen, A. Asgharian, V. J. Foster, A. Metz, C. B. Rockett, D. S. Wightman. (2005). Seasonal affective disorder and its prevention by anticipatory treatment with bupropion XL. Biological Psychiatry 58(8):658-667.

Seasonal Affective Disorder (SAD). (2020). CAMH. Retrieved from: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/seasonal-affective-disorder

Terman, M, J. S. Terman, F. M. Quitkin, P. J. McGrath, J. W. Stewart and B. Rafferty. (1989). Light therapy for seasonal affective disorder: a review of efficacy. Neuropsychopharmacology 2(1):1-22.