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Seasonal Affective Disorder (SAD): Causes, Symptoms, Diagnosis, Treatment And Prevention
As
the
days
are
short
during
the
winter
months,
many
individuals
struggle
with
seasonal
affective
disorder
(SAD),
a
recurrent
depressive
disorder
that
causes
sadness
and
loss
of
energy,
especially
during
the
months
of
December,
January
and
February.
It
is
estimated
that
10
to
20
per
cent
of
recurrent
depression
is
followed
by
a
seasonal
pattern.
SAD
is
a
common
disorder
and
mostly
young
adults
and
women
have
a
higher
chance
of
experiencing
SAD.
Adolescents
and
children
are
affected
by
SAD
too
[1].
What Causes Seasonal Affective Disorder? [2]
Seasonal
affective
disorder
(SAD),
commonly
known
as
winter
blues,
is
a
type
of
recurrent
depressive
disorder
that
occurs
with
changes
in
seasons.
It
usually
begins
in
the
fall
and
continues
throughout
the
winter
months.
It
can
also
occur
in
summer
but
the
prevalence
is
less.
Certain
factors
are
said
to
play
a
role
in
the
causes
of
SAD,
these
include:
• Low serotonin levels - When serotonin, a neurotransmitter responsible for the regulation of mood is at low levels, SAD occurs. SERT is a protein that helps in the transportation of serotonin from the synaptic cleft to the presynaptic neuron. Higher levels of SERT lower serotonin activity, thereby causing depression during the winter months. In the summer months, sunlight generally keeps the SERT levels low, but in the fall when the sunlight decreases, SERT increases and the serotonin levels become low.
•
Rise
in
melatonin
levels
-
Melatonin
is
a
hormone
produced
by
the
pineal
gland
that
regulates
the
sleep-wake
cycle.
Reduced
exposure
to
sunlight
during
the
winter
months
leads
to
an
overproduction
of
melatonin,
making
you
feel
sleepy
and
lethargic.
The
combination
of
increased
melatonin
and
decreased
serotonin
levels
causes
an
imbalance
in
the
circadian
rhythm
(the
body's
internal
24-hour
clock),
which
makes
it
difficult
for
the
body
to
adjust
during
the
winter
months,
especially
for
people
with
SAD.
• Lower vitamin D production - Less skin exposure to sunlight produces lower amount vitamin D. Vitamin D is believed to affect serotonin levels and deficiency of this vitamin causes depressive symptoms.
Ways To Get Out Of Bed When You Are Depressed
Symptoms Of Seasonal Affective Disorder
•
Sad
mood
•
Feeling
less
energetic
•
Irritable,
stressed
or
anxious
mood
•
Tired
and
lethargic
•
May
cry
frequently
•
Difficulty
in
concentrating
•
Sleeping
more
than
normal
•
Decrease
in
physical
activity
•
Avoiding
social
situations
•
Craving
for
carbohydrate
and
sugary
foods
•
Weight
gain
due
to
overeating
The symptoms of SAD in summer, which is a less common occurrence includes poor appetite, weight loss, insomnia, agitation, anxiety, restlessness and violent behaviour [3].
What Are The Physical Symptoms Of Depression?
Risk Factors Of Seasonal Affective Disorder
•
Women
between
18
to
30
years
are
four
times
more
likely
to
get
SAD
than
men
[4].
•
Family
history
of
depression
•
Bipolar
disorder
•
People
who
are
living
far
from
the
equator
in
northern
latitudes
[5].
Complications Of Seasonal Affective Disorder
•
Social
withdrawal
•
Problems
at
work
places
•
Substance
abuse
•
Suicidal
thoughts
or
behaviour
•
Other
mental
health
disorders
like
anxiety
disorders,
psychiatric
conditions
and
eating
disorders.
Diagnosis Of Seasonal Affective Disorder
A mental health professional will first conduct a physical exam and ask in-depth questions about your health. No medical tests are available for diagnosing this disorder; however, the doctor may perform a blood test to check if there are other illnesses or underlying conditions.
The diagnostic criteria for SAD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association are: [6]
• A person should have depression symptoms only at a specific time of the year ( e.g fall or winter) and fully disappearing at a certain time of the year (e.g spring).
• At least two episodes of depressive symptoms in the previous two years.
• People with SAD experience symptoms such as craving for carbohydrate foods, increase in appetite and hypersomnia.
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Treatment Of Seasonal Affective Disorder
Light therapy [7]
Light therapy, also known as bright light therapy or phototherapy has been shown to be effective in relieving the symptoms of SAD. It is a treatment procedure that involves the usage of light boxes that filter out ultraviolet rays and emit bright artificial light similar to sunlight. Sitting in front of a 10,000 lux of cool-white fluorescent light in the morning every day for 20 to 60 minutes, from early fall till spring can reduce the symptoms of SAD.
The side effects of light therapy are less severe and include headache, eye strain, irritation, difficulty in sleeping and increased risk of age-related macular degeneration [8].
Light therapy treatment should be monitored by a mental health professional.
Vitamin D [9]
Inadequate amounts of dietary intake of vitamin D and less sun exposure leads to vitamin D deficiency. People who live about 33 degrees north or 30 degrees south of the equator are unable to produce vitamin D during the winter months from November to February [10].
Taking vitamin D regularly before the winter darkness sets may help improve and prevent SAD symptoms.
Antidepressant medications [11]
Second generation antidepressants (SGAs), such as fluoxetine is a selective serotonin reuptake inhibitor (SSRI) is considered effective in the treatment of SAD. Another SGA SSRI called bupropion has also been widely used in the treatment of SAD.
Counselling [12]
Cognitive behavioural therapy (CBT) can be highly effective in the treatment of SAD. The aim of this therapy is to curb your negative thoughts, help deal with problems that look overwhelming and provide new ways in helping you to deal with low energy, stress and sadness through healthy ways.
Prevention Of Seasonal Affective Disorder
•
Eat
a
diet
rich
in
fruits
and
vegetables
•
Limit
sugary
and
starchy
foods
•
Exercise
daily
•
Manage
your
stress
•
Increase
sun
exposure
Common FAQs
Q. Do I have SAD?
A. The symptoms of SAD include feeling of hopelessness, depressed mood, fatigue, difficulty in concentrating, changes in sleep, poor appetite and suicidal thoughts.
Q. Does SAD get worse with age?
A. The risk of SAD lowers for adults as they age.
Q. Is crying every night normal?
A. Tearfulness is frequently linked to depression and anxiety. If you are tearful regularly over other normal activities in your life, that may be a sign of depression.
Q. Are SAD lights bad for your eyes?
A. Yes, they cause eye strain
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