With the days getting shorter as fall approaches, many people may experience seasonal affective disorder, or SAD. SAD is a form of depression brought on by the change of seasons. It most commonly causes people to become depressed in the fall or winter, but there are people who get it in the spring or summer. It’s important to distinguish SAD from the normal seasonal blues most people experience to some extent during the fall and winter. SAD is an episode of major depression, the symptoms of which include feeling depressed most of the time, feeling hopeless or worthless, fatigue, losing interest in things you used to enjoy, irritability, changes in appetite or weight, slow movements, difficulty concentrating, and thoughts of death or suicide. These must persist for two weeks to be considered depression. Winter SAD and summer SAD might have slightly different symptoms. Common symptoms of winter SAD include having little energy, sleeping too much, eating too much, craving carbs, and socially withdrawing or hibernating. Symptoms of summer SAD, on the other hand, include poor appetite, insomnia, agitation, anxiety, restlessness, and violent outbursts. We don’t know exactly what causes SAD. One factor might be that people who are prone to SAD have too little serotonin, a neurotransmitter thought to improve mood. One study found that people who experience SAD have higher levels of serotonin transporter proteins in the winter, reducing the levels of serotonin in the synapses. Another hypothesis is that the longer hours of darkness cause people with SAD to produce too much melatonin, causing them to sleep too much. A third hypothesis is that the shorter hours of sunlight during the winter leads to a vitamin D deficiency. Vitamin D does many important things, including regulating your immune system, hormones, and levels of serotonin. Low levels of vitamin D have been associated with depression. The risk factors for SAD are mostly the same as major depression. Of course, if you have already been diagnosed with major depression or bipolar disorder, the change of seasons is more likely to trigger a depressive episode. Women are more likely than men to experience SAD. Having a family history of depression makes SAD more likely, as does being young, as teens and young adults are at a higher risk of depression. One risk factor related specifically to the change of seasons is how far you live from the equator. Someone who lives in New England is about nine times more likely to experience SAD than someone who lives in Florida. So what can you do about SAD? If you’re experiencing SAD, don’t dismiss it as winter blues. Talk to your doctor about treatment. Here are some common ways of treating SAD.
As with other forms of depression, medication, typically SSRIs are often effective in treating SAD. These medications boost levels of serotonin, which are thought to be low in the winter months. These can take about four to six weeks to start working and you may have to try several different medications before you find one that works. More than half of people with depression improve significantly with the right medication.
Since lack of sunlight is thought to play a major role in SAD, it makes sense to try to compensate with artificial light. During the winter months, you may get out of bed in the dark, work all day inside, then go home in the dark. This causes two main problems. One is that your circadian rhythm is controlled by sunlight. It controls the release of hormones that make you tired and wake you up. When it’s always dark, you’re always tired. Light therapy may help your brain adapt to the lack of sunlight. A light box is a device you can set on your desk or table. It’s many times brighter than regular indoor lighting and it can fool your brain into thinking you’ve been exposed to normal morning sun. This helps you wake up and keep a more normal daily rhythm. The other problem with lack of sunlight is that you don’t produce as much vitamin D. As noted above, vitamin D is important for immunity, hormones, and serotonin. It’s mostly produced in the skin when exposed to sunlight. Too little sunlight means too little vitamin D. Light boxes won’t help you make more vitamin D because they don’t emit the ultraviolet light needed to stimulate vitamin D synthesis. One option for producing more vitamin D is to visit a tanning booth once a week, but that may also increase your risk of skin cancer.
Supplement with vitamin D
A more straightforward way to increase your levels of vitamin D without the need for tanning beds or increased risk of skin cancer is to simply supplement with vitamin D. You’ll want to have your doctor check your levels of vitamin D and, if they’re low, recommend a dosage for getting them back to normal. Typically, someone with low vitamin D levels should take a high dose for several months, then have her levels checked again. After that, she can switch to a lower maintenance dose. If your vitamin D levels are normal and you take high doses for a long time, you may get too much calcium in your blood, leading to symptoms like nausea, vomiting, and weakness. It can eventually lead to bone pain and kidney stones. So it’s very important to have your levels checked if you’re taking high dose supplements.
Just as with other forms of depression, cognitive behavioral therapy, or CBT, can be effective in treating SAD. CBT works by helping you change maladaptive beliefs and ways of thinking and by helping you identify activities you might enjoy, despite the lack of sunlight.
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