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What You Need to Know About Seasonal Affective Disorder (SAD)By Pamela L. Tippit, LPC-S



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As there is less light, it's cold outside, and there are holiday gatherings with friends (or maybe they are not friends!) and family, seasonal affective disorder can be an issue. Learn how to get through these dark, cold days full of high expectations and stress with as minimal issues as possible!

In the Diagnostic Manual of Mental Disorders (DSM-5), this disorder is identified as a type of depression: Major Depressive Disorder with Seasonal Pattern. This simply means that Seasonal Affective Disorder (SAD) is not a diagnosis of its own. It is a type of Major Depressive Disorder.

Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons. SAD begins and ends at about the same time every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. These symptoms often resolve during the spring and summer months. Less often, SAD causes depression in the spring or early summer and resolves during the fall or winter months.

Shorter daylight hours and less sunlight in the winter have been associated with SAD. As seasons change, people experience a shift in their biological internal clock, or circadian rhythm, that can cause them to be out of step with their daily schedule. SAD is more common in people living far from the equator, where there are fewer daylight hours in the winter.

Fall and Winter SAD

Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:

  • Oversleeping

  • Appetite changes, especially a craving for foods high in carbohydrates

  • Weight gain

  • Tiredness or low energy

  • Don't brush off that yearly feeling as simply a case of the "winter blues" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

Signs and symptoms of SAD may include:

  • Feeling listless, sad, or down most of the day, nearly every day

  • Losing interest in activities you once enjoyed

  • Having low energy and feeling sluggish

  • Having problems sleeping too much

  • Experiencing carbohydrate cravings, overeating, and weight gain

  • Having difficulty concentrating

  • Feeling hopeless, worthless, or guilty

  • Having thoughts of not wanting to live

SAD Treatment Modalities

Treatment for SAD may include light therapy (phototherapy), psychotherapy, and medications.

Light Therapy

Light therapy is one of the first-line treatments for fall-onset SAD. It generally starts working in a few days to a few weeks and causes very few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.

Before you purchase a light box, talk with your healthcare provider about the best one for you and familiarize yourself with the variety of features and options so that you buy a high-quality product that's safe and effective. Also, ask about how and when to use the lightbox. I use the Verilux® HappyLight® Luxe in my office.

Psychotherapy

Psychotherapy, also called talk therapy, is another option to treat SAD. A type of psychotherapy known as cognitive-behavioral therapy can help you:

  • Learn healthy ways to cope with SAD, especially by reducing avoidance behavior and scheduling meaningful activities.

  • Identify and change negative thoughts and behaviors that may be making you feel worse.

  • Learn how to manage stress

  • Build in healthy behaviors, such as increasing physical activity and improving your sleep patterns.

Medications

Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.


An extended-release version of the antidepressant bupropion (i.e., Wellbutrin XL, Aplenzin) may help prevent depressive episodes in people with a history of SAD. Other antidepressants may also be commonly used to treat SAD.

Your healthcare provider may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice the full benefits of an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.


Lifestyle and Home Remedies


  • Make your environment brighter. Open blinds to let in daylight, trim tree branches that block sunlight, or add skylights to your home. Sit closer to bright windows while at home or in the office.

  • Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can help, especially if you spend some time outside within two hours of getting up in the morning.

  • Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself, which can lift your mood.

  • Normalize sleep patterns. Schedule reliable times to wake up and go to bed each day. Especially for fall-winter-onset SAD, reduce or eliminate napping and oversleeping.

The best way to manage SAD is to stay ahead of it. Work on noticing your mood, behavioral patterns, and triggers (i.e.-holiday gatherings) during fall and winter.

If you feel you have symptoms of SAD, seek the help of a trained medical professional. Just as with other forms of depression, it is important to make sure there is no other medical condition causing symptoms. SAD can be misdiagnosed in the presence of hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections, so a proper evaluation is key. A mental health professional can diagnose the condition and discuss therapy options. With the right treatment, SAD can be a manageable condition.

If you feel your depression is severe or if you are experiencing suicidal thoughts, consult a doctor immediately or seek help at the closest emergency room. National Suicide Prevention Lifeline: 800-273-TALK (8255).




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