By: Katie Leach, MS, ATC/LAT

Have you ever gotten the wintertime blues? You may simply attribute this to missing the sun, the beach, or those well-deserved summer vacations, however, what if these melancholies are more than just that. What if you are really SAD? Seasonal Affective Disorder (SAD) is a type of depression that is linked to the changing seasons. Most people with SAD will experience an onset of symptoms in late fall or early winter with a resolution by spring or summer. In rare cases, individuals may have symptoms that begin in the late spring or summer and resolve in the fall. Overall, SAD is an uncommon condition, only affecting 2% of the population. Risk factors include: age, sex (F>M), distance from the equator, and family history of depression/bipolar disorder/SAD. To be diagnosed with SAD, individuals must meet the criteria for having a major depressive disorder and have recurrent symptoms that follow distinct seasonal patterns for at least two years. Below you will find symptoms of a major depressive disorder and SAD, as well as possible management strategies. (Melrose, 2015).

Depressive Disorder Symptoms

A major depressive disorder is a mood disorder that can affect all aspects of your life. To be diagnosed with a major depressive disorder an individual must have persistent symptoms for a minimum of two weeks. Below you will find a list of some of the symptoms associated with this condition.

· Lasting feelings of sadness, anxiety, irritability, hopelessness, pessimism, emptiness, guilt, worthlessness, or helplessness

· Lacking interest in work or activities that were once enjoyable

· Fatigue/low energy

· Difficulty sleeping or sleeping too much/little

· Loss of appetite

· Thoughts of death or suicide

· Physical pain and illness without a known cause

· Difficulty concentrating (“Depression,” 2016)

SAD Symptoms

SAD is unique because the symptoms are dependent on the season of the year. Below you will find the characteristics of this condition as it pertains to both the winter and summer onset.

Winter Pattern

· Sad mood

· Decreased energy

· Excessive sleepiness

· Eating too much; gaining weight

· Social withdrawal

· Carbohydrate cravings

Summer Pattern

· Lack of appetite; weight loss

· Inability to sleep

· Anxiety/nervousness

· Feeling restless

· Violent outbursts (Melrose, 2015).

Management Options

Below you will find some of the ways SAD may be managed.

1. Light Therapy

Bright light therapy (BLT) has become the standard for treating people with this condition. It involves using a fluorescent light box for greater than 20 minutes per day, preferably in the morning. Specific treatment times are based on the luminous emittance of these devices. Overall, this therapy has been shown to improve patient’s symptoms as early as one week to as late as four weeks. While these are optimistic results, consistency with light therapy is necessary to prevent a relapse in these effects (Praschak-Reider & Willeit, 2003).

Another form of light therapy that may be used for people with a winter onset of SAD is dawn stimulation. This therapy involves having a device that gradually increases the light in the bedroom until it is time to wake. This helps people arise easier in the mornings with reduced drowsiness (Praschak-Reider & Willeit, 2003).

2. Medication

Medication is another way to manage SAD. For some people it may be the sole treatment, whereas, others may benefit from a multifaceted approach. If medication is deemed appropriate Selective Serotonin Reuptake Inhibitors (SSRIs) may be recommended. SSRIs work by reducing the amount of serotonin that gets reabsorbed by the brain making more of it available (Ferguson, 2001). Serotonin plays a key role in sleep, appetite, mood, and a sense of well-being. If there is a deficiency in this neurotransmitter, regardless of cause, these feelings may thrive, resulting in potential depression (“Serotonin,” n.d.)

Some people may turn to medications other than SSRIs such as other antidepressants, melatonin, herbs, and nutritional supplements; however, no proof has been found that these are effective in treating this condition (Praschak-Reider & Willeit, 2003). In addition to medication, some patients may benefit from therapy.

3. Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is another way this condition may be managed. CBT is a form of therapy that uses behavioral changes and thought restructuring to improve coping mechanisms. It can be tailored to address the specific thoughts/behaviors of SAD patients. CBT has been shown to be as effective as light therapy when treating people with an acute onset of SAD. Furthermore, it may be more effective in preventing recurrences of symptoms entirely and/or reduce the severity of these symptoms should subsequent episodes develop (Rohan et al., 2015).

It is extremely important to recognize that this is a clinical disorder. It might be easy to find “self-help” remedies, however, they may not necessarily be appropriate for you. If you have any symptoms of a major depressive disorder or SAD you should consult with you Industrial Sports Medicine Professional or seek the advice of another medical professional.

References

Ferguson, J.M. (2001) SSRI antidepressant medications: Adverse effects and tolerability. The Primary Care Companion to the Journal of Clinical Psychiatry, 3 (1), 22-27. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/

Integrative Psychiatry (n.d.). Serotonin and Serotonin Deficiency. Retrieved January 22, 2018, from https://www.integrativepsychiatry.net/seritonin-and-seritonin-deficiency.html

Melrose, S. (2015). Seasonal Affective Disorder: An overview of Assessment and treatment approaches. Depression Research and Treatment, 2015, 1-6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673349/pdf/DRT2015-178564.pdf

National Institute of Mental Health (2016, October). Depression. Retrieved January 22, 2018, from https://www.nimh.nih.gov/health/topics/depression/index.shtml

Praschak-Rieder, N., & Willeit, M. (2003). Treatment of seasonal affective disorders. Dialogues in clinical neuroscience, 5 (4), 389-398. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181778/

Rohan, K.J., Mohan, J.N., Evans, M., Ho, S.Y., Meyerhoff, J., Postolache, T., Vacek, P.M. (2015). Randomized trial of cognitive-behavioral therapy versus light therapy for seasonal affective disorder: Acute

outcomes. American Journal of Psychiatry, 172 (9), 862-869. Retrieved from https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2015.14101293

Katie Leach

Katie Leach

Industrial Sports Medicine Professional

Katie is an Industrial Sports Medicine Provider with InSite Health. She is a Board-Certified Athletic trainer with a bachelor’s degree in Athletic Training from Southern Illinois University – Carbondale and a master’s degree in Kinesiology and Health from the University of Wyoming. She has 5 years of athletic training experience in the university, clinical, and industrial settings.