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Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) is characterized by periods of depression that coincide with seasonal changes during the year. It is most often noted in late fall and winter, alternating with periods of normal or high mood the rest of the year. Seasonal Affective Disorder is also called Seasonal Depression, and it is more than just a case of the winter blues or the cabin fever that can occur when a person stays indoors in the winter for long periods because of cold or accumulated snow. A rare form of SAD known as ‘Summer Depression’ begins in late spring or early summer and ends in the fall. Most SAD patients are adult women, although adult men, children and adolescents also report symptoms of this disorder. It is believed that SAD is caused by a biochemical imbalance in the hypothalamus that occurs as a result of shorter periods of daylight in winter. However, it is clear that more research is required to determine the cause(s) of SAD. A family history of depressive disorders and a high coincidence of other disorders in SAD patients may indicate more complex causal relationships. For example, atypical depressive symptoms of hypersomnia, hyperphagia, and weight gain occur more often in SAD patients as compared to patients that do not suffer from seasonal disorders.

Whatever the cause(s), SAD can be a disabling illness, preventing normal function in patients. It can result in debilitating depression, weight gain, increased sleep, decreased activity and a loss of interest in sex. In patients who suffer from the ‘winter blues’, symptoms are much less debilitating and typically do not require treatment. SAD patients seem to generate a biological signal of seasonal change that is absent in people who do not have SAD. The signal is similar to the one used to regulate changes in mammalian seasonal behavior. These patients also exhibit an increased release of Melatonin during the course of this seasonal disorder. Melatonin is a naturally occurring hormone secreted by the pineal gland in the brain, and it regulates the internal body clock.

What are the symptoms?

The average annual onset of SAD symptoms begins in October or November and subsides in March or April, though some patients may begin to feel the effects as early as August, and some do not exhibit symptoms until January. Some patients begin to slump as early as August, while others remain well until January.

Symptoms include:

• Sadness, irritability, depression
• Loss of interest in usual activities, withdrawal from social activities
• Desire to spend more time alone
• Summer Depression: Weight loss, trouble sleeping, decreased appetite
• Fatigue, lack of energy, increased need for sleep
• Increased appetite, weight gain, craves carbohydrates
• Inability to concentrate

How is it diagnosed and treated?

Doctors will perform a full medical and mental evaluation to rule out other disease or illness and the coincidence of other disorders that may also require treatment. SAD is often misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections.

Diagnostic criteria can include the following:

• Disorder occurs in a patient who lives more than 30 degrees from the Equator (SAD is rare in people who live near the equator where sunlight is relatively constant throughout the year)
• Craves carbohydrates and sweet foods, gains weight in the winter
• Feels depressed, guilty, hopeless, apathetic or numb
• 3 consecutive years of seasonal symptoms
• Fatigued and unable to pursue normal daily routine, increases sleep time and may oversleep in the morning
• Avoids social contact, is tense, irritable, cannot tolerate stress
• Symptoms disappear in Spring with full remission in Spring and Summer
• Weakened immune system

Treatment(s) can include:

• Phototherapy or Bright Light Therapy to suppress secretion of melatonin
• Psychotherapy
• Nutritional Counseling
• Medication as appropriate: anti-depressants (SSRIs)
• Daily exposure to natural sunlight
• Daily exercise

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