Seasonal Affective Disorder

There is no denying that wintertime in Chicago can be a very long and gloomy few months. Once the cold fall weather sets in and the clouds have blanketed the sky, it can feel as if the sun goes into hibernation until March. Mentally, emotionally, and physically, this time of year can be more difficult for people compared to the warmer and sunnier months. Many people attribute a drop in their mood to be simply, “the winter blues” (Cleveland Clinic 2020) while others may have the sense that something more serious is at play but may not have a definitive name for the phenomenon. According to the fifth edition of the Diagnostic Statistical Manuel, published in 2013, seasonal affective disorder (SAD) is a form of depression, considered to be a major depressive disorder with a seasonal pattern (Torres, 2020). This is a very real, clinical diagnosis that may be happening more frequently than you realize.

While symptoms may seem minor, this is not something to be taken lightly or ignored. Reports from the Cleveland Clinic in 2020 found that nearly 5% of all adults in the United States struggle with SAD. And from that 5%, nearly 75% of them are women (Cleveland Clinic, 2020). Hormonal shifts can impact SAD which could be one possible reason why so many more women are affected. Although the direct causes of SAD are still unknown, doctors and researchers have identified a few clear contributing factors. These include a person’s biological clock (circadian rhythm) and the way the lack of sunlight during the winter months affects a person’s internal clock. Serotonin levels can also contribute to SAD due to the lessened production of serotonin because of the lack of sunlight.

Finally, melatonin levels can fluctuate during different seasons which can affect a person’s sleep patterns and mood (Cleveland Clinic, 2020) (Mayo Clinic, 2017). All of these factors could be contributing to someone’s diminishing mental health during the winter months possibly without them even being aware.
In a hospital setting, there are undoubtedly women seeking medical care who may simultaneously be struggling with SAD without realizing it. In general, the symptoms of SAD mimic generalized anxiety disorder including irritability, difficulty concentrating, anxiety, sadness, fatigue, social/emotional withdrawal, lack of interest in usually pleasurable activities, increased need for sleep (Cleveland Clinic, 2020) (Mayo Clinic, 2017).

In a 2015 study conducted by Danilenko & Ivanova, treatment methods for SAD were explored. Two different types of light simulators were tested for effectiveness and popularity (Danilenko & Ivanova, 2015). One common device used to help people cope with SAD is a bright light simulator. These lamps can be purchased from a variety of retailers in a range of costs as well. The second device used is a dawn simulator. Unlike the bright light lamp that creates a steady outpouring of light similar to natural sunlight, the dawn simulator is intended to imitate a sunrise. In this way, the amount of light emitted gradually increases, mimicking a sunrise, to help a person wake up with a more natural lighting atmosphere. At the end of the study, it became clear to the researchers that both devices were successful in helping to elevate people’s moods and the distinction really came down to personal preference (Danilenko & Ivanova, 2015).

Additional research has been done to investigate the effectiveness of medications with SAD. Pjrek et. al, conducted several studies with different medications in 2007 and again in 2008. Two of the medications examined were agomelatine (Valdoxan) and duloxetine (Cymbalta). The Valdoxan is an antidepressant that targets receptors of both serotonin and melatonin. Valdoxan was shown to be effective in reducing symptoms specific to disruptions in the circadian rhythm and sleep patterns as well as daytime fatigue (Pjrek et. al, 2007). This research was conducted over a fourteen-week period and the patients were shown to tolerate the medication very well with little to no side effects. The second study with Cymbalta was also shown to be effective for patients. Cymbalta is an SSNRI and works with the receptors for both serotonin and norepinephrine (Pjek et. al, 2008).

Noticing signs and symptoms of SAD specifically can help people be more aware of what is truly happening with them internally. The more awareness we can bring to SAD, hopefully, the more likely people will speak up about how they truly feel. Additionally, the hope is for clinicians, workers, friends, and families to all be more aware of the presentation of this diagnosis in order to better help the people around us.
Here at Hopeful Beginnings, we are a resource of support for women and mothers who may be experiencing SAD in addition to other perinatal mood disorders. Please do not hesitate to reach out for assistance or send referrals our way. We are always here to help.

Sources:
Danilenko, K. V., & Ivanova, I. A. (2015). Dawn simulation vs. bright light in seasonal affective disorder: Treatment effects and subjective preference. Journal of affective disorders, 180, 87-89.
Pjrek, E., Winkler, D., Konstantinidis, A., Willeit, M., Praschak-Rieder, N., & Kasper, S. (2007). Agomelatine in the treatment of seasonal affective disorder. Psychopharmacology, 190(4), 575-579.
Pjrek, E., Willeit, M., Praschak-Rieder, N., Konstantinidis, A., Semlitsch, H. V., Kasper, S., & Winkler, D. (2008). Treatment of seasonal affective disorder with duloxetine: an open-label study. Pharmacopsychiatry, 41(03), 100-105.
Seasonal Depression (SAD): Symptoms & Treatments. (n.d.). (12/7/2020). Retrieved January 13, 2021, from https://my.clevelandclinic.org/health/diseases/9293-seasonal-depression
Torres, F., M.D, MBA, DFAPA. (2020, October). Seasonal Affective Disorder (SAD). Retrieved January 13, 2021, from https://www.psychiatry.org/patients-families/depression/seasonal-affective-disorder
Seasonal affective disorder (SAD). (2017, October 25). Retrieved January 15, 2021, from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651