Living with Seasonal Affective Disorder

Living with Seasonal Affective Disorder doesn’t have to be the downer its morose acronym suggests. 

Every autumn as days grow shorter and sunlight wanes, some people’s mood takes a nosedive. They may call it depression, but it’s not. This downward spiral is known as autumn SAD, a disorder that persists until spring and the sun return.

A relative newcomer to the medical scene, SAD has been recognized only within the last 20 years. Unlike many other disorders, its trigger is well known. Dr. Nancy Low, a psychiatrist, assistant professor and staff clinician and researcher in the MUHC’s Mood Disorders program, explains what’s at work:

“We’re certain that SAD is tied into the seasons and the shift in light that begins in early fall. In countries lying close to the equator, its prevalence is almost zero. The farther away from the equator, north or south, the higher the incidence. In the U.S. SAD affects about one percent of the population; in Canada, about two percent.

“Every cell of the human body has an internal clock specific for work the cell does, which we call its circadian rhythm. Our bodies are very sensitive to light and shifts in those rhythms. Researchers suspect that an abnormality in the circadian function of brain cells is related to our perception of light and that’s what accounts for the change in mood as fall gives way to winter.”

Women 4 to 1

       Women are about four times likelier than men to get SAD. It suggests that female hormones play a part, as the odds are equal for everyone before the age of 16, then even out again after 55. SAD generally occurs in the thirties or forties. If you’ve been diagnosed with depression you’re more vulnerable. It’s not strictly hereditary, but if someone else in your family suffers from depression, that also increases your risk for SAD.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) identifies SAD as a sub-type of depression. It feels a lot like it, but not exactly. Apart from the sadness, fatigue and lack of energy, there may be stomach aches and headaches. People find they eat more and especially crave carbohydrates, often gaining weight as a consequence. Two major differences: while those with SAD tend to sleep longer hours, they don’t have to cope with the insomnia typical of depression. Most important, neither are they plagued with thoughts of suicide.

The DSM also identifies SAD as a sub-type of bipolar disorder, one that reacts to the seasons. “It may seem strange at first, but in patients with bipolar autumn may trigger either depression, mania or hypomania,” says Low. “The Affective in Seasonal Affective Disorder just means mood, which can be high or low. People with bipolar can sometimes trigger a manic episode simply by traveling across time zones, which shifts their circadian rhythm. Holidaying on your own in hot countries can be dangerous if the time zone change triggers your mania and no one realizes what you’re usually like.” Low knows of worried parents who have sent detectives down to the Caribbean to find their ill adult children.

You may have heard of summer SAD. Some deem it a true diagnostic entity, a direct contrast to autumn SAD, wherein low moods are triggered by sunshine. Not everyone agrees, however, and that group includes Low. “All the reading I’ve done and the patients I’ve seen, if you really have SAD the problem should resolve itself during the summer. Some people mistake SAD for what we call an ‘anniversary reaction.’ A death or other negative life event occurs — it could be any season — and people regularly feel sad at that time. Having undiagnosed symptoms can rob your life of pleasure. That’s why it’s important to be diagnosed.” Your GP or a psychiatrist is the person to call.

See the light

       There are several ways of treating SAD. Going outside won’t give you the intensity of light you need, but light therapy will. It’s simple and effective, a lamp about twice the width of a computer screen that you use at home. Sit about 18 inches away for half an hour a day in the morning, eyes open but don’t stare into it. Look for a lamp without ultraviolet rays and with an intensity of 10,000 Lux. Average price: around $250. Some companies allow you to try a lamp for two weeks, by which time you should know if the therapy is working. You need to continue the treatment until spring.

SAD can also be treated with antidepressants or cognitive behavioural therapy.

“Living with depressive symptoms for a good part of the year, you lose interest in the things you once enjoyed,” says Low. “You avoid your friends, become less social and develop negative thinking patterns: ‘I’m not lovable, not worthy, I’ll fail at anything I try.’ Talk therapy can help you eliminate those thoughts before they become a permanent part of your personality.”

There’s also plenty you can do to help yourself. Being proactive is the key. Starting in the fall, sign up for an exercise regime and go at least three times a week. Socializing and being productive are important — join a book club, a walking group, a cooking class. If you love food, plan to try a new meal every week. And fall could be the perfect time to delay SAD’s impact by taking a warm-weather vacation.

Before anything, though, Low advises you to get diagnosed. “You may think you have SAD, but your mood could be due to another condition entirely — hormonal change, hypothyroidism, iron-deficiency anemia or even pregnancy.”

And if you do indeed have SAD, look on the bright side. It’s a problem you can do plenty to alleviate.

From Share & Care, Winter 2014