Seasonal affective disorder is not just a case of the holiday blues

Many people experience sadness, fatigue and a lack of interest in daily life when days get shorter and weather gets colder. That might just be the “holiday blues,” but it also could be a medical condition known as seasonal affective disorder.When the days become shorter and the weather gets colder, many people experience sadness, fatigue and a lack of interest in daily life. Those feelings could be nothing more than “holiday blues” or exhaustion. But more severe, persistent depression that comes and goes with the seasons may be a medical condition known as seasonal affective disorder, or SAD. A medical expert from the University of Alabama at Birmingham recommends learning how to spot the signs of SAD and getting help if you think you have the condition.

Matthew Macaluso, D.O., clinical director of UAB Medicine’s Depression and Suicide Center, says SAD is a form of depression with a recurrent seasonal pattern, with symptoms lasting four to five months per year or longer.

There are two kinds of SAD. Winter-pattern SAD starts in the late fall or early winter and resolves during the spring and summer. Other people may experience depressive episodes during the spring and summer months, although summer-pattern SAD is less common.

SAD symptoms may match those caused by major depression, but not every person with SAD will experience all the symptoms listed below. Symptoms of major depression may include:

• Feeling depressed on most days
• Losing interest in activities you once enjoyed
• Changes in appetite or weight
• Difficulty falling or staying asleep
• Low energy
• Feeling hopeless or worthless
• Difficulty concentrating

• Frequent thoughts of death or suicide

For winter-pattern SAD, additional specific symptoms may include:

• Oversleeping
• Overeating, with a craving for carbohydrates
• Weight gain
• Social withdrawal (feeling as though you are hibernating)

Matthew Macaluso, D.O.
Photography: Lexi CoonCauses and risks

Macaluso says the exact causes of SAD are not known, but extensive research shows certain risk patterns.

“If you have a preexisting psychiatric illness, such as anxiety or substance abuse, then you may be at greater risk for SAD,” Macaluso said. “Age and family medical history may increase your risk as well. People living in a northern geographic region, where winter brings short days with very little sunlight, have a greater risk of developing SAD than people who see more sunlight.”

Macaluso is referring to the way researchers believe sunlight affects sleep cycles and brain chemistry. Here is what is known:

• Reduced levels of sunlight may disrupt the body’s internal clock (circadian rhythm), which regulates sleep and alertness. A shift in circadian rhythm causes a sense of being out of step with one’s normal routine, which may lead to depression.
• Reduced sunlight can cause a drop in serotonin, a brain chemical that affects mood. Vitamin D, which the body produces when exposed to sunlight, is believed to promote serotonin activity.
• Other findings suggest that people with SAD produce too much melatonin, a hormone involved in maintaining the normal sleep-wake cycle. Overproduction of melatonin can increase sleepiness.

Treatment

Macaluso says people experiencing symptoms related to SAD should track their mood and habits.

“Transient mood changes and temporarily feeling down can be normal responses to typical holiday stress,” he said. “But if you feel down for many days and can’t get motivated to do activities you normally enjoy, don’t write that off as ‘the winter blues.’”

Macaluso also said that if sleep patterns and appetite have changed, the feeling hopelessness presents, thoughts about suicide or alcohol or drugs are used, then it is time to see a doctor.

Treatment options could include:

• Medication. Some people with SAD benefit from antidepressant treatment. Your doctor may want you to start this medication before your symptoms usually begin each year. Your doctor also may recommend that you continue medication even after your symptoms improve.
• Light therapy. Also called phototherapy, it involves spending 30 minutes per day in front of a specially designed lamp. Light therapy mimics natural sunlight and appears to cause a change in brain chemicals that affect mood.
• Psychotherapy. Psychotherapy, or talk therapy, can help you identify and change negative thoughts and behaviors that may be making you feel worse. You can also learn healthy ways to cope with SAD and manage stress.